Type VII secretion system and its effect on group B Streptococcus virulence in isolates obtained from newborns with early onset disease and colonized pregnant women.

Introduction: GBS may cause a devastating disease in newborns. In early onset disease of the newborn the bacteria are acquired from the colonized mother during delivery. We characterized type VII secretion system (T7SS), exporting small proteins of the WXG100 superfamily, in group B Streptococci (GBS) isolates from pregnant colonized women and newborns with early onset disease (EOD) to better understand T7SS contribution to virulence in these different clinical scenarios. Methods: GBS genomes [N=33, 17 EOD isolates (serotype III/ST17) and 16 colonizing isolates (12 serotype VI/ST1, one serotype VI/ST19, one serotype VI/ST6, and two serotype 3/ST19)] were analyzed for presence of T7SS genes and genes encoding WXG100 proteins. We also perform bioinformatic analysis. Galleria mellonella larvae were used to compare virulence between colonizing, EOD, and mutant EOD isolates. The EOD isolate number 118659 (III/ST17) was used for knocking out the essC gene encoding a membrane-bound ATPase, considered the driver of T7SS. Results: Most GBS T7SS loci encoded core component genes: essC, membrane-embedded proteins (essA; essB), modulators of T7SS activity (esaA; esaB; esaC) and effectors: [esxA (SAG1039); esxB (SAG1030)].Bioinformatic analysis indicated that based on sequence type (ST) the clinicalGBS isolates encode at least three distinct subtypes of T7SS machinery. In all ST1isolates we identified two copies of esxA gene (encoding putative WXG100proteins), when only 23.5% of the ST17 isolates harbored the esxA gene. Five ST17isolates encoded two copies of the essC gene. Orphaned WXG100 molecule(SAG0230), distinct from T7SS locus, were found in all tested strains, except inST17 strains where the locus was found in only 23.5% of the isolates. In ST6 andST19 isolates most of the structure T7SS genes were missing. EOD isolates demonstrated enhanced virulence in G. mellonella modelcompared to colonizing isolates. The 118659DessC strain was attenuated in itskilling ability, and the larvae were more effective in eradicating 118659DessC. Conclusions: We demonstrated that T7SS plays a role during infection. Knocking out the essC gene, considered the driver of T7SS, decreased the virulence of ST17 responsible for EOD, causing them to be less virulent comparable to the virulence observed in colonizing isolates.

Group B streptococcus virulence factors associated with different clinical syndromes: Asymptomatic carriage in pregnant women and early-onset disease in the newborn.

Background: Group B streptococcus (GBS) harbors many virulence factors but there is limited data regarding their importance in colonization in pregnancy and early-onset disease (EOD) in the newborn. We hypothesized that colonization and EOD are associated with different distribution and expression of virulence factors. Methods: We studied 36 GBS EOD and 234 GBS isolates collected during routine screening. Virulence genes (pilus-like structures-PI-1, PI-2a, PI-2b; rib and hvgA) presence and expression were identified by PCR and qRT-PCR. Whole genome sequencing (WGS) and comparative genomic analyses were used to compare coding sequences (CDSs) of colonizing and EOD isolates. Results: Serotype III (ST17) was significantly associated with EOD and serotype VI (ST1) with colonization. hvgA and rib genes were more prevalent among EOD isolates (58.3 and 77.8%, respectively; p < 0.01). The pilus loci PI-2b and PI-2a were more prevalent among EOD isolates (61.1%, p < 0.01), while the pilus loci PI-2a and PI-1 among colonizing isolates (89.7 and 93.1% vs. 55.6 and 69.4%, p < 0.01). qRT PCR analysis revealed that hvgA was barely expressed in colonizing isolates, even though the gene was detected. Expression of the rib gene and PI-2b was two-fold higher in EOD isolates compared to colonizing isolates. Transcription of PI-2a was three-fold higher in colonizing isolates compared to EOD isolates. ST17 isolates (associated with EOD) had a smaller genome size compared ST1 and the genome was more conserved relative to the reference strain and ST17 isolates. In a multivariate logistic regression analysis virulence factors independently associated with EOD were serotype 3, and PI-1 and PI-2a was protective. Conclusion: There was a significant difference in the distribution of hvg A, rib, and PI genes among EOD (serotype III/ST17) and colonizing (serotype VI/ST1) isolates suggesting an association between invasive disease and these virulence factors. Further study is needed to understand the contribution of these genes to GBS virulence.

All disease begins in the gut: Celiac disease co-existence with SLE.

BACKGROUND: Case reports and case series have indicated a possible association between celiac disease (CD) and systemic lupus erythematosus (SLE), but additional population-based studies are required. The true prevalence of CD in SLE patients is still unknown, but is indeed an important factor when considering the clinical implications, notably the necessity of screening strategies in SLE patients. Our objective was to investigate the association between CD and SLE using a community-based approach in a real-life population database. METHODS: Patients with SLE were compared with age- and sex-matched controls regarding the prevalence of CD in a case-control study. Chi-square and t-tests were used for univariate analysis and a logistic regression model was used for multivariate analysis. The study was performed utilizing the medical database of Clalit Health Services. RESULTS: The study included 5018 patients with SLE and 25,090 age- and sex-matched controls. The prevalence of CD was significantly higher in patients with SLE than in controls in univariate analysis (0.8% and 0.2%, respectively, p<0.001). Also, SLE was associated with CD (OR 3.92, 95% CI 2.55-6.03, p<0.001) in a multivariate logistic regression model. CONCLUSIONS: Patients with SLE had a greater prevalence of CD than matched controls in a large case-control study. A complex combination of genetic, immunological and novel environmental factors may explain this positive association. Physicians should keep in mind that CD can be a tricky diagnosis in SLE patients, yet a treatable condition, probably more common in this population than we used to think.

Hyperthyroidism association with SLE, lessons from real-life data--A case-control study.

BACKGROUND: Despite the frequently encountered association between thyroid disease and systemic lupus erythematosus (SLE) is well known, it is of surprise that only several reports compromised of small population size support this observation. OBJECTIVES: To investigate the association of comorbid SLE and hyperthyroidism. METHODS: Using the database of the largest health maintenance organization (HMO) in Israel, the Clalit Health Services, we searched for the co-existence of SLE and hyperthyroidism. Patients with SLE were compared with age- and sex-matched controls regarding the prevalence of hyperthyroidism in a case-control study. Chi-square and t-tests were used for univariate analysis and a logistic regression model was used for multivariate analysis. RESULTS: The study included 5018 patients with SLE and 25,090 age- and sex- matched controls. The prevalence of hyperthyroidism in patients with SLE was increased compared with the prevalence in controls (2.59% and 0.91%, respectively, p < 0.001). In a multivariate analysis, SLE was associated with hyperthyroidism (odds ratio 2.52, 95% confidence interval 2.028-3.137). CONCLUSIONS: Patients with SLE have a greater prevalence of hyperthyroidism than matched controls. Therefore, physicians treating patients with SLE should be aware of this possibility of this thyroid dysfunction.

Metabolic syndrome: a risk factor for high intraocular pressure in the Israeli population.

AIM: To evaluate the association among elevated intraocular pressure (IOP), the metabolic syndrome (MetS), body mass index (BMI), and some of their components in the Israeli population. METHODS: We retrospectively reviewed the charts of 12 747 soldiers of the Israeli Defense Forces, aged 35y or older, who underwent a routine periodical medical examination between 1991 and 2004. None of the subjects received medical treatment for either glaucoma or ocular hypertension. High IOP (>21 mm Hg) was correlated with age, sex, arterial blood pressure, total blood cholesterol levels, triglyceride levels, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, smoking, BMI and MetS. RESULTS: A statistically significant difference was found between the IOP of subjects with a low risk and higher risk for the development of MetS (P<0.0001 for males, P=0.0026 for females). A statistically significant positive correlation was found in male subjects between high BMI and elevated IOP (r=0.11677, P<0.0001). CONCLUSION: MetS and BMI were significantly more prevalent in subjects with increased IOP levels. We suggest that both should be taken into consideration in the assessment of glaucoma suspects.

Changes in triglyceride levels over time and risk of type 2 diabetes in young men.

OBJECTIVE: The association between changes in triglyceride concentrations over time and diabetes is unknown. We assessed whether two triglyceride determinations obtained 5 years apart can predict incident type 2 diabetes. RESEARCH DESIGN AND METHODS: Triglyceride levels at baseline (time 1) and 5 years later (time 2), followed by subsequent follow-up of 5.5 years, were measured in 13,953 apparently healthy men (age 26-45 years) with triglycerides <300 mg/dl (<3.39 mmol/l). RESULTS: During 76,742 person-years, 322 cases of diabetes occurred. A multivariate model adjusted for age, BMI, total cholesterol-to-HDL cholesterol ratio, family history of diabetes, fasting glucose, blood pressure, physical activity, and smoking status revealed a continuous independent rise in incident diabetes with increasing time 1 triglyceride levels (P(trend) < 0.001). Men in the lowest tertile of time 1 triglyceride levels who progressed to the highest tertile over follow-up (low-high) exhibited a hazard ratio (HR) of 12.62 (95% CI 3.52-31.34) compared with those remaining in the lowest tertile at both time points (reference group: low-low). Whereas men who were at the top triglyceride level tertile throughout follow-up (high-high) had a HR for diabetes of 7.08 (2.52-14.45), those whose triglyceride level decreased to the lowest tertile (high-low) exhibited a HR of 1.97 (0.67-6.13). Alterations in triglyceride levels during follow-up were associated with changes in BMI, physical activity, and eating breakfast habit (P < 0.05), but remained an independent modifier of diabetes risk even after adjustment for such changes. CONCLUSIONS: Two measurements of fasting triglyceride levels obtained 5 years apart can assist in identifying apparently healthy young men at increased risk for diabetes, independent of traditional risk factors and of associated changes in BMI and lifestyle parameters.

Family history of cardiovascular disease does not predict risk-reducing behavior.

BACKGROUND: Family history is one of the main risk factors for cardiovascular disease, especially in the younger population. These individuals, being closely related to young symptomatic patients, are anticipated to have a high rate of risk factors but also to control them aggressively. The aim of the study was to evaluate the association between family history of cardiovascular disease and risk factors that control as well as reduce risk-reducing behavior among young, healthy adults. DESIGN AND METHODS: Demographic, clinical and lifestyle parameters of career service personnel of the Israeli Defense Forces, who were checked at the staff periodic examination center, were evaluated. Behavioral and clinical parameters of participants, with and without cardiovascular family history, were compared. RESULTS: The study cohort comprised 41,099 patients (36,236 men and 4863 women). Of those, 3802 men and 628 women with a family history of cardiovascular disease were identified. Male individuals had a higher rate of treatable risk factors like, obesity (P<0.0005), high blood pressure (P<0.0005), high plasma glucose (P<0.0005) and dyslipidemia (P<0.0005) than individuals without a family history. Among the women, the rate of these risk factors was higher than in the control groups but was statistically significant only for obesity, high blood pressure and high glucose levels. Risk-reducing behavior like regular physical activity and nonsmoking status in both the sexes did not differ between the groups. CONCLUSION: Members of the young population with a family history of cardiovascular disease is easily identified but remains largely uncontrolled. Special attention and continued education are required to modify their behavioral and medical parameters.

Changes in triglyceride levels and risk for coronary heart disease in young men.

BACKGROUND: Current triglyceride levels might be only a weak predictor of risk for coronary heart disease (CHD). OBJECTIVE: To assess the association between changes over time in fasting triglyceride levels and CHD risk in young adults. DESIGN: Follow-up study over 5.5 years after 2 measurements of fasting triglycerides 5 years apart. SETTING: The Staff Periodic Examination Center of the Israel Defense Forces, Zrifin, Israel. PATIENTS: 13,953 apparently healthy, untreated, young men (age 26 to 45 years) with triglyceride levels less than 3.39 mmol/L (<300 mg/dL). MEASUREMENTS: Two triglyceride measurements (at enrollment [time 1] and 5 years later [time 2]), lifestyle variables, and incident cases of angiography-proven CHD. RESULTS: Within 5.5 years, 158 new cases of CHD were identified. The multivariate model was adjusted for age; family history; fasting glucose; high-density lipoprotein cholesterol; blood pressure; body mass index; and changes between time 1 and time 2 in body mass index, physical activity, smoking status, and habit of eating breakfast. Investigators categorized triglyceride levels according to low, intermediate, and high tertiles (as measured at time 1 and time 2 [expressed as tertile at time 1/tertile at time 2]). The risk for CHD in men with high-tertile triglyceride levels at time 1 changed depending on the tertile at time 2 (hazard ratios, 8.23 [95% CI, 2.50 to 27.13] for high/high, 6.84 [CI, 1.95 to 23.98] for high/intermediate, and 4.90 [CI, 1.01 to 24.55] for high/low, compared with the stable low/low group). The risk for CHD in men with low-tertile levels at time 1 also changed depending on the tertile at time 2 (hazard ratios, 3.81 [CI, 0.96 to 15.31] for low/intermediate and 6.76 [CI, 1.34 to 33.92] for low/high, compared with the stable low/low group). LIMITATIONS: Participants were healthy and had a low incidence rate of CHD. The study was observational. CONCLUSIONS: Two triglyceride measurements obtained 5 years apart may assist in assessing CHD risk in young men. A decrease in initially elevated triglyceride levels is associated with a decrease in CHD risk compared with stable high triglyceride levels. However, this risk remains higher than in those with persistently low triglyceride levels.

Blood-pressure categories in adolescence predict development of hypertension in accordance with the European guidelines.

BACKGROUND: It is estimated that by 2025, >1.5 billion adults worldwide will be hypertensive. Early identification of the population at risk would lead to improved utilization of preventive measures. We aimed to evaluate whether baseline body mass index (BMI) and blood-pressure (BP) values during adolescence (categorized according to the guidelines of the European Society of Hypertension-European Society of Cardiology) are of use in predicting the development of hypertension in young adulthood. METHODS: The study population consisted of 18,513 male regular army personnel who were initially recruited at 16.5 and 19 years of age between 1976 and 1996. The main outcome was the percentage of subjects who developed hypertension (> or =140 systolic and > or =90 diastolic) at ages 26 to 45 years. RESULTS: At baseline, BP categories were: optimal, 5961 (32.2%); normal, 7998 (43.2%); and high normal, 4554 (24.6%). Moreover, 1377 (7.4%) were overweight (BMI 25-30 kg/m(2)), and 199 (1.1%) were obese (BMI >30 kg/m(2)). At follow-up, 2277 (12.3%) subjects developed hypertension. The percentages progressing to hypertension were 9.46%, 11.99%, and 16.56% for optimal, normal, and high-normal categories, respectively (P < .01). Odds ratios (OR) for the development of hypertension in the normal and high-normal categories versus optimal were 1.30 (95% confidence interval [CI], 1.22-1.39) and 1.79 (95% CI, 1.67-1.93), respectively, adjusted for age and BMI. The ORs for hypertension in overweight and obese versus normal BMI were 1.75 (95% CI, 1.66-1.86) and 3.75 (95% CI, 3.45-4.07), adjusted for age and BP. Of 9762 remaining at ideal BMI at follow-up, the percentages progressing to hypertension were 5.3%, 6.4%, and 9.5% for optimal, normal, and high normal (at baseline) (P < .01). CONCLUSIONS: The risk of developing hypertension in young adulthood may be predicted by BP categories and BMI at adolescence.

The prevalence of reversible cardiovascular risk factors in Israelis aged 25-55 years.

BACKGROUND: Coronary heart disease is a major cause of morbidity and mortality worldwide. Early detection of cardiovascular risk factors and intervention may reduce consequential morbidity and mortality. OBJECTIVES: To assess the prevalence of reversible and treatable cardiovascular risk factors among 26,477 healthy Israeli adults: 23,339 men and 3138 women aged 25-55 years. METHODS: We collected data during routine examinations performed as part of a screening program for Israel Defense Force personnel. RESULTS: The three most prevalent cardiovascular risk factors were a sedentary lifestyle (64%), dyslipidemia (55.1%) and smoking (26.8%). Overall, 52.9% of the men and 48.4% of the women had two or more cardiovascular risk factors. Moreover, 52.4% of young adult men and 43.3% of young adult women, age 25-34 years, had two or more reversible cardiovascular risk factors. CONCLUSIONS: In this expectedly healthy population there was a high prevalence of reversible and treatable cardiovascular risk factors in both genders and in young ages. These observations stress the need for routine health examinations and lifestyle modification programs even in the young healthy Israeli population.

Prehypertension and obesity in adolescents: a population study.

BACKGROUND: Current blood pressure (BP) classification is based on the recent recommendations of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC-7) and the 2003 European Society of Hypertension-European Society of Cardiology Guidelines for the Management of Arterial Hypertension. The JNC-7 introduced a new concept, prehypertension, and recommended health-promoting lifestyle modifications for these individuals. Obesity is also recognized as a major risk factor for the development of hypertension. We aimed to determine the prevalence of hypertension and obesity in a large cohort of adolescents and to assess whether prehypertension and body mass index (BMI) increase with increasing age. METHODS: A cross-sectional population-based study was performed using data collected during 1996 to 2002 in an army recruitment examination of 560,588 Israeli individuals 16.5 to 19 years of age. The subjects were divided according to gender and stratified by increasing 6-month intervals into five groups. Prehypertension was defined as BP 120 to 139 / 80 to 89 mm Hg. Overweight was defined as BMI 25 to < or = 30 and obesity as BMI >30 kg/m2. RESULTS: Mean systolic BP (SBP) and diastolic BP (DBP) were significantly higher in male subjects for all groups. By applying the JNC-7 criteria, 56.8% of male subjects and 35.8% of female subjects would be considered prehypertensive. There was a statistically significant increase in the mean SBP and DBP with age and BMI. Among male subjects 10.9% were overweight and 3.3% were obese; among female subjects, 11.1% were overweight and 3.2% were obese. The BMI did not increase with increasing age. The prevalence of prehypertension was significantly higher in obese subjects. CONCLUSIONS: Prehypertension is very common among Israeli adolescents. A substantial number of adolescents exhibit a BMI greater than normal. As both of these factors are known to be asssociated with increased cardiovascular risk, early institution of healthful lifestyle changes in a large proportion of this age group is recommended.

Normal fasting plasma glucose levels and type 2 diabetes in young men.

BACKGROUND: The normal fasting plasma glucose level was recently defined as less than 100 mg per deciliter (5.55 mmol per liter). Whether higher fasting plasma glucose levels within this range independently predict type 2 diabetes in young adults is unclear. METHODS: We obtained blood measurements, data from physical examinations, and medical and lifestyle information from men in the Israel Defense Forces who were 26 to 45 years of age. RESULTS: A total of 208 incident cases of type 2 diabetes occurred during 74,309 person-years of follow-up (from 1992 through 2004) among 13,163 subjects who had baseline fasting plasma glucose levels of less than 100 mg per deciliter. A multivariate model, adjusted for age, family history of diabetes, body-mass index, physical-activity level, smoking status, and serum triglyceride levels, revealed a progressively increased risk of type 2 diabetes in men with fasting plasma glucose levels of 87 mg per deciliter (4.83 mmol per liter) or more, as compared with those whose levels were in the bottom quintile (less than 81 mg per deciliter [4.5 mmol per liter], P for trend <0.001). In multivariate models, men with serum triglyceride levels of 150 mg per deciliter (1.69 mmol per liter) or more, combined with fasting plasma glucose levels of 91 to 99 mg per deciliter (5.05 to 5.50 mmol per liter), had a hazard ratio of 8.23 (95 percent confidence interval, 3.6 to 19.0) for diabetes, as compared with men with a combined triglyceride level of less than 150 mg per deciliter and fasting glucose levels of less than 86 mg per deciliter (4.77 mmol per liter). The joint effect of a body-mass index (the weight in kilograms divided by the square of the height in meters) of 30 or more and a fasting plasma glucose level of 91 to 99 mg per deciliter resulted in a hazard ratio of 8.29 (95 percent confidence interval, 3.8 to 17.8), as compared with a body-mass index of less than 25 and a fasting plasma glucose level of less than 86 mg per deciliter. CONCLUSIONS: Higher fasting plasma glucose levels within the normoglycemic range constitute an independent risk factor for type 2 diabetes among young men, and such levels may help, along with body-mass index and triglyceride levels, to identify apparently healthy men at increased risk for diabetes.

Association between erectile dysfunction and sleep disorders measured by self-assessment questionnaires in adult men.

BACKGROUND: Erectile dysfunction (ED) is often associated with sleep disorders and sleep apnea syndrome (SAS) in mostly middle-aged and elderly men. Sleep disorders and ED are also prevalent in younger men. PURPOSE: To study the association between ED, sleep disorders, and SAS, particularly among adult men. METHODS: A health screening program is offered by the Israel Defense Force (IDF) for career servicemen older than 25 years, for the purpose of early detection of ED and sleep disorders, among other concealed morbidities. The Sexual Health Inventory for Man questionnaire (SHIM) was used to measure ED. The Sleep Quality (SQ) questionnaire, developed by the medical services of the IDF, was used to characterize SAS and other sleep disorders. RESULTS: From 2002 through 2003, 3,363 men (mean age, 36.1+/-6.8 years) replied to the SHIM and SQ questionnaires. Of these men, 337 (10%) scored high (>or=25) in the SQ questionnaire, suggesting moderate to severe sleep disorders, and 870 men (25.8%) scored low (

Low scores in the sexual health inventory for men questionnaire may indicate sexual disorders other than erectile dysfunction.

INTRODUCTION: A screening program aimed at early detection of erectile dysfunction, among other hidden morbidities, is offered by the medical services of the Israel Defense Force for career servicemen. Men apparently with erectile dysfunction can turn to a sexual rehabilitation specialist for consultation. AIM: To present our experience in sexual evaluation of men with low scores in the Sexual Health Inventory for Men (SHIM) questionnaire. METHODS: Men aged 25-50 years go through a routine check-up at the Staff Periodic Examination Center. The SHIM questionnaire was used to characterize erectile dysfunction. Men who had scored low in the SHIM questionnaire were referred to a sexual consultation and evaluation. RESULTS: During 2001-2003, 11,914 men reported to the Staff Periodic Examination Center (mean age 34.8 +/- 7.1 years). Among 5,836 men who filled out the SHIM questionnaire (compliance of 48.9%), 1,570 (26.9%) men scored low. Of those men with low SHIM scores, 7.2% (114/1,570) underwent a sexual dysfunction evaluation. Only 50% (57/114) of the men in fact had erectile dysfunction, of whom 15.7% (9/57) also had premature ejaculation. In addition, 38.5% (44/114) of the men were found to have premature ejaculation only, and the rest (14/114, 9.7%) had other sexual dysfunctions or lack of sexual knowledge. CONCLUSION: The SHIM questionnaire is a valuable tool for detecting various sexual dysfunctions other than erectile dysfunction. Incorporating the SHIM questionnaire in a routine check-up encourages men to seek consultation and treatment for sexual disorders. In addition, the SHIM questionnaire encourages men to seek sexual education and increase their awareness of issues concerning sexual health.

Prevalence of erectile dysfunction among young adults: results of a large-scale survey.

INTRODUCTION: Erectile dysfunction (ED) can be an early and first sign of an underlying systemic disease. A screening program is offered by the Medical services of the Israel Defense Force for career servicemen at the Staff Periodic Examination Center (SPEC) aimed at early detection of morbidity. The Sexual Human Inventory for Males (SHIM) questionnaire was introduced to these men in order to identify ED, to offer men with ED suitable treatment options, and to investigate underlying systemic diseases. AIM: To provide epidemiological data regarding the prevalence of ED among a large-scale young adult population. METHODS: Subjects aged 25-50 years are undergoing a routine check-up at SPEC. Blood samples, physiological measures, demographic variables, information on health status and smoking habits are recorded and documented. The SHIM self-administrated questionnaire was used to characterize ED. RESULTS: During 2001-2003, 11,914 males reported to SPEC (average age 34.8 +/- 7.1 years). Five thousand eight hundred thirty-six of them chose to answer the SHIM questionnaire (compliance of 48.9%). According to the SHIM scores, at least one out of three men (26.9%) suffered from ED (19%, 7%, and 1% had mild, moderate, and severe ED, respectively). ED was prevalent also among young adults: 22.1% of males under-40 had low SHIM scores (<21). Severity of ED correlated with age and diabetes mellitus. CONCLUSION: In light of these results, we conclude that ED is a major health concern among young men as well. Incorporating questions regarding sexual health in a routine check-up may encourage more men to seek treatment, not only for ED, but also for underlying diseases.

Is idiopathic ventricular fibrillation a short QT syndrome? Comparison of QT intervals of patients with idiopathic ventricular fibrillation and healthy controls.

OBJECTIVE: The purpose of this study was to determine if patients with idiopathic ventricular fibrillation (VF) have shorter QT intervals than comparable healthy controls. BACKGROUND: The upper limit of the normal QT is well defined. Less is known about the lower limit of the normal QT. Patients with the recently described "short QT syndrome" have characteristics resembling those of patients with idiopathic VF. METHODS: The ECGs of 28 consecutive patients with idiopathic VF (17 men and 11 women, age 31 +/- 17 years) were compared to those of 270 age- and gender- matched healthy controls. Based on published literature, we defined "short QT" as QTc < or = 360 ms for males and < or = 370 ms for females. RESULTS: Despite significant overlapping, the QTc of males with idiopathic VF was shorter than the QTc of healthy males (371 +/- 22 ms vs 385 +/- 19 ms, P = .034). Short QT intervals were found more frequently among males with idiopathic VF (35% vs 10%, P = .003). No such differences were apparent among women. Short QTc intervals were more commonly seen during bradycardia. However, the correlation between short QT and a history of VF was independent of heart rate. CONCLUSIONS: "Short" QTc values are commonly seen in male patients with idiopathic VF. However, "short" QTc values are not rare among healthy adults, especially at slow heart rates. Further studies are needed to define when a given QT is really "too short."

Recommendations for nursing requirements at a field hospital, based on the Israel Defense Forces field hospital at the earthquake disaster in Turkey--August 1999.

On the 17th of August 1999, an earthquake of 7.4 magnitude on the Richter Scale struck the Marmara region in Turkey causing a massive casualties event with an estimated 2,680 deaths and 5,300 injuries just at the city of Adapazari alone. A field hospital was set up by the Israel Defense Forces at Adapazari in order to provide temporary medical services until regular medical forces recovered. The aim of the paper is to overview the requirements of the nursing staff at a field hospital based on our experience and analysis of the nursing activity at the field hospital at Adapazari. The methods implemented include interviewing all nurses and many of the doctors who took part in the field hospital as well as a review of medical literature about disasters. We found an inverted nurse:phycisian ratio of 1:1.77, as opposed to a 2.5-3:1 ratio in regular civilian hospitals. The nurses in our field hospital had to work longer and more intensive shifts than in a regular hospital. They had to overcome language barriers and cultural differences, and faced difficult hygiene conditions. Our overview analysis of results brought up several recommendations. Firstly, although it is not possible to predictthe number and types of casualties, it is necessary to provide an adequate number of nurses (1-1.5:1 nurse:physician ratio). Furthermore, the nurses should be specialized and rotated as needed. Secondly, the language and cultural barriers should not be undermined despite the abundance of translators. Finally, the hygiene status in a field hospital requires management by nurses with active participation of all members.