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עמוד בית
Tue, 03.10.23

July 2016 (32)

Lt. Col. Dr. Adi Leiba
After a timeout of about two quarters, I am proud to announce that the journal "Military Medicine" (- JIMM
Journal of Israeli Military Medicine) republished its publication.
From now on, the summer of 2016, onwards, will be published four issues a year, on a quarterly basis.
On the 13th anniversary of its founding, one of the main ambitions before us is to upgrade the status of "military medicine" to be recognized in Pubmed / Medline, as compatible with the standards of the international medical journals included in these leading search engines.
As a quality scientific journal, well-known and listed in the search engines, the goal is to bring it to an impact factor score within 5 years.
Ethics In Medicine
Lt. Col. Dr. Adi Leiba
The research in military medicine in Israel is conducted in accordance with the instructions of the Karpar and under the guidance of an academic branch, and is implemented in accordance with the principles and guidelines of the Helsinki Committee of the Medical Corps.
The main points of the policy document below present guiding emphases and ethical principles regarding scientific publication
In the journal "Military Medicine", based on the policy of the Medical Corps as well as on a position paper
Centers on behalf of the Israel Ethics Bureau: "Ethical Rules in Scientific Publication", January 2006.
Guy Beck, Zvi H. Perry, Ayala Cohen, Gad Shaked
To cite this article: Beck G, Perry ZH, Cohen A, Shaked G.
Trauma Patients in Southern Israel. Harefuah Hatsvait (Journal
of Israeli Military Medicine). 2016 Jul;13(32):8-12. Hebrew.
Introduction: The transportation of patients from a medical
center to a level 3 trauma center is considered one of the
weak links in the chain of survival in trauma patients. It is
well known for decades that in order to enhance survivability
and reduce morbidity in trauma patients one has to reduce
the time from injury to the time of definitive medical
treatment. Even though previous studies have shown a
survival advantage for patients who were treated in level 3
trauma centers, there is less data from patients who were
transferred from less qualified trauma centers.
Methods: The current study included 172 patients who were
transported from the Yoseftal Medical center, a peripheral
hospital, to Soroka University Medical Center which is a level
3 trauma center. Data was gathered from an electronic data
base of the trauma unit, which is a part of the Israeli trauma
registry run by the Gertner Institute. Data analysis included
descriptive and analytical statistics, including propensity
score which enabled us to counter biases like the tendency
to send the most badly injured patients by helicopters.
Results: Of the 172 patients included, 56 (32.6%) were women.
The average age was 32 (±18.6). The average hospitalization
time after admission to SUMC was 9.1 days (±11.5). 27 patients
suffered from penetrating injuries (15.7%), 149 patients from
blunt injuries (86/6%) and12 patients from burns (7%). Some
patients suffered both blunt and penetrating injury and/or
burns, thus the numbers add up to more than 100%. Longer
hospitalization times were found for patients who according to
the severity of their trauma, should have been evacuated with
an intensive care unit, either airborne or on the ground, and
were not transported by these means, in comparison to the
patients who were transported properly.
Conclusions: The current study tried to evaluate if airborne
evacuation is more efficient than regular ambulance
transportation. The variables found significantly different
were GCS, age, torso injury and type of injury. Our results
have shown that there is a mismatch between type of
transportation and type of injury – of the 115 who were
not evacuated by helicopter, 6 patients (5%) had the
characteristics which necessitated a helicopter evacuation,
and of the 57 patients who were transported by a helicopter
or ICU ambulance 30 (53%) did not have the characteristics
which necessitated a helicopter evacuation. Those who
are in favor of helicopter evacuation believe that the
risks involved in this type of sophisticated evacuation are
minimized in comparison to the advantages of the treatment
options that are found in a level 3 trauma center even
though there is a lack of hard core data to support that view.
Our study has shown that in order to benefit from these
advantages there is a need for an optimal triage process
before transport, or else the risks involved in this process
outweigh the advantages.
Capt. Lev Dorfman1, Maj. Tamar Sela, Lital Keinan-Boker, Maj. Michal Grinberg1, Lt. Col. Yoseph Yerushalmi1, Maj. Dorit Tzur1, Lt. Col. Hadar Elad1
To cite this article: Dorfman L, Sela T, Keinan-Boker L,
Grinberg M, Yerushalmi Y, Tzur D, Elad H. Mycosis Fungoides
among IDF Soldiers. Harefuah Hatsvait (Journal of Israeli
Military Medicine). 2016 Jul;13(32):13-16. Hebrew.
Abstract: Mycosis Fungoides (MF) is the most common
subtype of cutaneous T cell lymphoma. The etiology of MF
is unclear. Genetic abnormality might contribute to the
pathogenesis of the disease.
The incidence of MF in the USA and Europe is approximately
0.6 cases per 100,000 persons per year. Patients under
20 years old constitute only 0.5%-2.3% of MF patients.
The purpose of this study is to describe recent cases of
MF diagnosed in the IDF, to provide details concerning
the accumulating incidence of MF in recent years and to
compare between MF incidence among IDF soldiers to MF
incidence in the general population of Israel.
Methods: Descriptive and retrospective cohort studies were
committed. Medical records of IDF soldiers during 2004-
2012 were screened for diagnosis of MF. MF incidence in
the age group of 18-22 was compared to the incidence at the
same age group in the general population. Data concerning
the incidence of MF in the civilian population was obtained
from the Israel National Cancer Registry.
Results: In 2012 7 new MF cases were detected among IDF
MF incidence between 2004-2010 was 1.64 per 100,000
persons per year in 18-22 years old IDF soldiers, similar
incidence was detected in both genders. MF incidence in the
general population was 0.74 cases per 100,000 persons peryear, at the same age group. Standardized incidence Ratio
(SIR) was 2.21 (SD 1.05; 4.72) p value=0.02.
Conclusions: No epidemiological clusters in MF incidence
among IDF soldiers were detected. However, a diagnosis of
MF at the age group of 18-22 years is not rare.
We found statistically significant difference between MF
incidence among IDF soldiers compared to the general
population. However, as more than 2/3 of MF cases were
not registered at the Israel National Cancer Registry,
underestimation in the reported incidence of MF in the
general population is likely.
We assume that the difference in the incidence is due to this
incomplete data.
This study is unique as it focuses on MF among the young
adult population, demonstrating an incidence that differs
considerably from that, reported in previous studies.
Maj. Amir Ytzhak, Capt. Odelya Avrahami, Col. Moshe Pinkart
To cite this article: Ytzhak A, Avrahami O, Pinkart M. Dietary
Intervention in the Military Kitchen – A Health Promoting Tool
for Soldiers. Harefuah Hatsvait (Journal of Israeli Military
Medicine). 2016 Jul;13(32):17-21. Hebrew.
Introduction: Unhealthy diet and lack of physical activity are
risk factors for obesity and cardiovascular diseases.
Health promotion programs in work places that include a
change in food offer were found to have moderate efficacy.
Goal: Feasibility study of an intervention program at the
level of the food offer at military bases, serving as a tool for
health promotion of soldiers.
Method: “Healthy Food Project” was implemented for two
years in 23 military bases (about 15,000 soldiers). The
project included instructions to kitchens, and advocacy
activities on food and fitness. Implementation of the
guidelines was tested using a control report. Additionally,
the impact on food composition was examined using a
computerized food system.
Results: The consumption of canola and soybean oil was
decreased by 8%. The consumption of sugar dropped by
27%, and the consumption of whole wheat increased by
187%. 10 bases in which control was performed both in
2012 and in 2013 demonstrated improvement in the control
scores from 82.9 ± 5.7 to 87.4 ± 5.2 (student t-test 0.066).
There was a significant improvement of the grades for
serving cut vegetables and fresh salads, warm additions
quality including warm vegetables and whole grains and
reducing deep frying.
Conclusions: Fundamental change in the military menu
according to nutritional standards is a complex task that
requires the collaboration of medical and logistics personnel
and the support of commanders, all in military units that
perform ongoing operations.
The “healthy food project” demonstrated feasibility of dietary
intervention at the level of supply of healthy food in military
bases kitchens. Continued work will focus on the impact of
environmental change on soldiers’ health. •
NEJM in the battalion aid station
Ofir Vinograd
Lower back pain and leg pain are common complaints in military medicine and medicine in general.
Two-thirds of the adult population will experience back pain at least once in their lifetime.
10% report back pain radiating to below the knee for three months. My pain
Backs are the main cause of disability in working age and military service, up to age 45.
The peak incidence of pain from the lumbar disc source is among those aged 40-30.
Case Reports
Lt. Erez Marcuson, Maj. Constantin Zubkov, Col. Tarif Bader
To cite this article: Marcuson E, Zubkov C, Bader T. Dietary
Intervention in the Military Kitchen – A Health Promoting
Tool for Soldiers. Harefuah Hatsvait (Journal of Israeli
Military Medicine). 2016 Jul;13(32):24-25. Hebrew.
Objective: We report a case of a rare urologic problem –
thrombosis of the dorsal vein of the penis.
Clinical features: A 18-years-old soldier was presented to
his battalion physician with complaints on penile exfoliation
and itching, the local dermatological empirical treatment
was started.
On urologic follow-up examination, after negative semen
and urine culture, a thrombosis of superficial dorsal vein of
penis was suspected. Ultrasound Doppler study confirmed
a diagnosis and treatment with aspirin was started for 3
months. Laboratory studies for coagulation problems were
normal. Repeated US Doppler study was normal too after
3-month’s period.
Conclusions: Mondor’s disease is a rare pathology that
appears in young men population and could challenge
primary physicians. Despite the benign process of the
disease, circumstances and clinical features cause much
suffering to the patient.
Capt. Albert Grinshpun, Capt. Talia Grossman, Capt. Ariel Hirsch, Capt. Alexandra Satanovsky, Capt. Dolev Frid, Maj. Ran Yanovich
Overuse injuries are a significant burden on athletes and
military personnel, representing the most common cause
of medical-orthopedic attrition from frontline active duty.
In recent years, a diagnostic scoring prediction tool named
Functional Movement Score (FMS) has been developed.
The FMS examines the function of fundamental movement
patterns in order to detect weakness and imbalance which
ultimately may lead to injury. The method consists of a series
of seven simple functional tasks which can be quantitatively
scored and focuses on both upper and lower body parts. This
screening system was tested in a range of civilian and military
populations with variable success rates.
The aim of the review is to present the contemporary literature
on this subject and to expose the readers to a potentially
significant tool in reducing overuse injuries.
Maj. Galit Bidner, Maj. Ilana Gens, Col. Avi Abargel
Geologically, Israel is located at the junction of three tectonic plates.
Seismic activity occurs in the replicas between the plates, and they are the focus of earthquakes.
According to historical evidence of the last millennium, every 100-80 years on average a strong earthquake occurs in the State of Israel.
No such earthquake has occurred since the establishment of the state, yet Israel is preparing for the scenario
Complex on a national, local and organizational scale, characterized by great uncertainty that makes it difficult
Optimal organization of the relevant bodies, and requires a coordinated response.
This article reviews the earthquake phenomenon, presents the history of earthquakes in Israel
Over the years and describes the deployment framework set in the country, alongside the unique characteristics
To the scenario, the medical challenges it poses, and the perception of the health system's response to this scenario.
Conference Reports
Itay Fogel
International Conference of the American Society of Microbiology (ASM)
The Biodefense and Emerging Diseases Research Meeting, held in Washington DC in February 2015, discusses dealing with the Ebola virus.
Known or emerging pathogens, such as Ebola, have serious consequences for public health, and can be maliciously produced, or manifest in natural outbreaks.
The conference included hundreds of researchers, physicians and public health professionals from around the world. This year the conference focused on the Ebola outbreak in West Africa in 2014 and the lessons learned to prevent
Future outbreaks. The conference sessions dealt with a selection of key issues related to the causative agents of the epidemics: bacterial diseases, viral diseases, infectious diseases and innovative ways of dealing with them.
Below are some of the key lessons and insights that emerged at the conference and are also relevant to the management of similar events in Israel.
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