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1.
Isr Med Assoc J ; 21(11): 728-731, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31713360

RESUMO

BACKGROUND: Evaluation of low rectal anastomosis is often recommended prior to ostomy closure, but the efficacy of such evaluations is uncertain. OBJECTIVES: To assess whether routine colonic preoperative evaluation has an effect on postoperative ileostomy closure results. METHODS: We performed a retrospective study evaluating all patients who underwent ileostomy closure over 9 years. Patient demographics, clinical, surgical details, and surgical outcomes were recorded and analyzed. RESULTS: The study comprised 116 patients who underwent ileostomy closure, of them 65 were male (56%) with a mean age of 61 years (range 20-91). Overall, 98 patients (84.4%) underwent colonic preoperative evaluation prior to ileostomy closure. A contrast enema was performed on 61 patients (62.2%). Abnormal preoperative results were observed in 12 patients (12.2%). The overall complication rate was 35.3% (41 patients). No differences in postoperative outcome was observed in patient gender (P = 1), age (P = 0.96), body mass index (P = 0.24), American Society of Anesthesiologists score (P = 0.21), and the Charlson Comorbidity Index score (P = 0.93). Among patients who had postoperative complications, we did not observe a difference between patients who underwent preoperative evaluation compared to those who did not (P = 0.42). No differences were observed among patients with preoperative findings interpreted as normal or abnormal (P = 1). The time difference between ileostomy creation and closure had no effect on the ileostomy closure outcome (P = 0.34). CONCLUSIONS: Abnormal findings in preoperative colonic evaluation prior to ileostomy closure were not associated with worse postoperative outcome.


Assuntos
Colo/anormalidades , Ileostomia , Cuidados Pré-Operatórios , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica , Colonoscopia , Enema , Feminino , Humanos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos
2.
Isr Med Assoc J ; 21(11): 732-737, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31713361

RESUMO

BACKGROUND: Anastomotic leakage (AL) is a major complication following colorectal surgery, with many risk factors established to date. The incidence of AL varies in the medical literature and is dependent on research inclusion criteria and diagnostic criteria. OBJECTIVES: To determine the incidence of and the potential risk factors for AL following colorectal surgery at a single academic medical center. METHODS: We retrospectively reviewed all operative reports of colorectal procedures that included bowel resection and primary bowel anastomosis performed at Sheba Medical Center during 2012. AL was defined according to the 1991 United Kingdom Surgical Infection Study Group criteria. Data were assessed for leak incidence within 30 days. In addition, 17 possible risk factors for leakage were analyzed. A literature review was conducted. RESULTS: This cohort study comprised 260 patients, and included 261 procedures performed during the study period. The overall leak rate was 8.4%. In a univariate analysis, male sex (odds ratio [OR] 3.37, 95% confidence interval [95%CI] 1.21-9.43), pulmonary disease (OR 3.99, 95%CI 1.49-10.73), current or past smoking (OR 2.93, 95%CI 1.21-7.10), and American Society of Anesthesiologist score ≥ 3 (OR 3.08, 95%CI 1.16-8.13) were associated with an increased risk for anastomotic leakage. In a multivariate analysis, male gender (OR 3.62, 95%CI 1.27-10.33) and pulmonary disease (OR 4.37, 95%CI 1.58-12.10) were associated with a greater risk. CONCLUSIONS: The incidence of AL in the present study is similar to that found in comparable series. Respiratory co-morbidity and male sex were found to be the most significant risk factors.


Assuntos
Fístula Anastomótica/epidemiologia , Fístula Anastomótica/etiologia , Cirurgia Colorretal , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
3.
Isr Med Assoc J ; 21(10): 662-665, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31599507

RESUMO

BACKGROUND: Crohn's disease and ulcerative colitis are the two major classic presentations of inflammatory bowel diseases (IBD). Studies have shown a wide variation in the incidence and prevalence attributed to different geographic and ethnic populations. OBJECTIVES: To assess the clinical characteristics of IBD among Arabs in Israel and to compare them to characteristics of IBD among Ashkenazi Jews. METHODS: This retrospective, comparative study compared the clinical characteristics of IBD among 150 Arabs from the Holy Family Hospital and the Nazareth Hospital EMMS, both located in Nazareth, Israel, to those of 97 age- and sex-matched Ashkenazi Jewish patients from Shaare Zedek Medical Center, Jerusalem, Israel. RESULTS: The Arab cohort, which included 106 patients (70%) with Crohn's disease and 44 (29%) with ulcerative colitis, was compared to 97 Ashkenazi patients (81% with Crohn's disease and 17% with ulcerative colitis) (P < 0.05). Alcohol consumption was found in both groups, but Arabs smoked more (46% vs. 12%, respectively, P < 0.05). Obstructive phenotype was lower in Arabs (10% vs. 32%, P < 0.05). 5-aminosalicylic acid and anti-tumor necrosis factor alpha were prescribed for the Arab and Ashkenazi groups (89% and 21%, respectively). The need for surgical intervention due to disease severity and/or complications was not significant (22% vs. 24%). CONCLUSIONS: Despite similar reports of NOD2/CARD15 mutations, Crohn's disease is more common than ulcerative colitis within the Arab-Israeli population. Increased smoking rates may explain milder disease severities in Arabs, as reflected by lower obstructive pattern and frequent use of milder therapeutic modalities.


Assuntos
Árabes/estatística & dados numéricos , Doenças Inflamatórias Intestinais/epidemiologia , Judeus/estatística & dados numéricos , Adulto , Estudos de Coortes , Comorbidade , Feminino , Humanos , Israel/epidemiologia , Masculino , Estudos Retrospectivos , Fumar/epidemiologia , Adulto Jovem
4.
Isr Med Assoc J ; 21(10): 692-695, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31599513

RESUMO

BACKGROUND: Data suggest that subclinical hypothyroidism (SCH) is associated with progression of chronic renal disease; however, no study to date has assessed the possible relation between SCH and acute deterioration of renal function. OBJECTIVES: To investigate the possible relation between SCH and acute kidney injury (AKI) in a large cohort of patients with ST-elevation myocardial infarction (STEMI) treated with primary coronary intervention (PCI). METHODS: We evaluated thyroid stimulating hormone (TSH) and free T4 levels of 1591 STEMI patients with no known history of hypothyroidism or thyroid replacement treatment who were admitted to the coronary care unit (October 2007-August 2017). The presence of SCH was defined as TSH levels ≥ 5 mU/ml in the presence of normal free T4 levels. Patients were assessed for development of AKI ( 0.3 mg/dl increase in serum creatinine, according to the KDIGO criteria). RESULTS: The presence of SCH was demonstrated in 68/1593 (4.2%) STEMI patients. Patients presenting with SCH had more AKI complications during the course of STEMI (20.6% vs. 9.6 %; P = 0.003) and had significantly higher serum creatinine change throughout hospitalization (0.19 mg/dl vs. 0.08 mg/dl, P = 0.04). No significant difference was present in groups regarding baseline renal function and the amount of contrast volume delivered during coronary angiography. In multivariate logistic regression model, SCH was independently associated with AKI (odds ratio = 2.19, 95% confidence interval 1.05-4.54, P =0.04). CONCLUSIONS: Among STEMI patients treated with PCI, the presence of SCH is common and may serve as a significant marker for AKI.


Assuntos
Lesão Renal Aguda/epidemiologia , Hipotireoidismo/epidemiologia , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Lesão Renal Aguda/fisiopatologia , Estudos de Coortes , Comorbidade , Feminino , Humanos , Hipotireoidismo/fisiopatologia , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia
5.
Isr Med Assoc J ; 21(9): 589-594, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31542902

RESUMO

BACKGROUND: Cryptosporidium is a major threat to water supplies worldwide. Various biases and obstacles in case identification are recognized. In Israel, Cryptosporidiosis was included among notifiable diseases in 2001 in order to determine the burden of parasite-inflicted morbidity and to justify budgeting a central drinking water filtration plant. OBJECTIVES: To summarize the epidemiologic features of 14 years of Cryptosporidium surveillance and to assess the effects of advanced water purification treatment on the burden of disease. METHODS: From 2001 to 2014, a passive surveillance system was used. Cases were identified based on microscopic detection in stool samples. Confirmed cases were reported electronically to the Israeli Ministry of Health. Overall rates as well as age, gender, ethnicity and specific annual incidence were calculated per 100,000 population in five age groups: 0-4, 5-14, 15-44, 45-64, > 65 years. RESULTS: A total of 522 Cryptosporidium cases were reported in all six public health districts. More cases were detected among Jews and among males, and mainly in young children, with a seasonal peak during summer. The Haifa sub-district reported 69% of the cases. Most were linked to an outbreak from the summer of 2008, which was attributed to recreational swimming pool activity. Cases decreased after installation of a central filtration plant in 2007. CONCLUSIONS: As drinking water in Israel is treated to maximal international standards, the rationale for further inclusion of Cryptosporidium among mandatory notifiable diseases should be reconsidered. Future surveillance efforts should focus on timely detection of outbreaks using molecular high-throughput testing.


Assuntos
Criptosporidiose/epidemiologia , Cryptosporidium/isolamento & purificação , Monitoramento Epidemiológico , Política de Saúde , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Incidência , Lactente , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Vigilância da População/métodos , Estações do Ano , Fatores Sexuais , Purificação da Água/estatística & dados numéricos , Abastecimento de Água/estatística & dados numéricos , Adulto Jovem
6.
Isr Med Assoc J ; 21(8): 512-515, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31474008

RESUMO

BACKGROUND: Breast implant-associated anaplastic large cell lymphoma (ALCL) is a rare type of non-Hodgkin's lymphoma that is found around breast implants. ALCL was discovered only two decades ago. In Israel we currently have four diagnosed cases (as of 2018). Until recently, the estimated incidence was 1:300,000 women with breast implants, while recent reports range from 1:3817 to 1:30,000. OBJECTIVES: To determine the occurrence of breast implant-ALCL in Israel. METHODS: We conducted a retrospective analysis of the four patients diagnosed with ALCL in Israel. Cytology was confirmed and the clinical data was collected. Based on the estimated number of women with breast implants in Israel, a calculation of the true incidence was completed. RESULTS: The incidence in Israel is significantly higher than the older incidence reports indicate. We estimated that the lifetime prevalence of the disease is 4:60,000 women with a textured breast implant, or 1:15,000 women with a textured breast implant in Israel. CONCLUSIONS: ALCL is not common. We support the claim that the prevalence is significantly higher than what was initially described. This finding has clinical and medicolegal implications that should be addressed accordingly.


Assuntos
Implantes de Mama/efeitos adversos , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Linfoma Anaplásico de Células Grandes/diagnóstico , Linfoma Anaplásico de Células Grandes/epidemiologia , Adulto , Mama/cirurgia , Neoplasias da Mama/cirurgia , Remoção de Dispositivo , Feminino , Humanos , Israel/epidemiologia , Linfoma Anaplásico de Células Grandes/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos
7.
Isr Med Assoc J ; 21(8): 538-541, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31474016

RESUMO

BACKGROUND: Travelers' diarrhea (TD) is frequently encountered in people traveling from high-income to low-income countries; however, its epidemiology in those traveling between high-income countries is not known. OBJECTIVES: To evaluate the incidence of diarrhea in North American students relocating to Israel. METHODS: A retrospective cohort study involving medical students from the United States and Canada relocating to Israel was conducted. Students who relocated to Israel during 2010-2016 were contacted by email to participate in an anonymous survey. Data included demographic information as well as occurrence, timing, duration, and outcome of diarrhea after relocation. RESULTS: Ninety-seven students participated in the survey. Most (93.7%) students relocated from the United States or Canada. The period-prevalence of diarrhea was 69.1%. The incidence of diarrhea declined from 34.8 cases per 100 student-months during the first month after relocation to 1.3 cases per 100 student-months after 1 year. The duration of diarrhea was up to 1 week in 72.7%. Students who reported diarrhea were younger than students who did not (mean age 24.0 ± 2.2 and 28.4 ± 1.8 years, respectively, P < 0.001). No other demographic parameter was significantly associated with a higher likelihood of diarrhea. CONCLUSIONS: A high proportion of North American medical students relocating to Israel reported diarrhea with clinical and epidemiological features similar to classic TD. Further studies are needed to elucidate the causative agents of TD in Israel.


Assuntos
Diarreia/epidemiologia , Inquéritos Epidemiológicos/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Doença Relacionada a Viagens , Doença Aguda , Adulto , Canadá/etnologia , Estudos de Coortes , Diarreia/etnologia , Feminino , Humanos , Incidência , Israel/epidemiologia , Masculino , Projetos Piloto , Estudos Retrospectivos , Viagem , Estados Unidos/etnologia , Adulto Jovem
8.
Isr Med Assoc J ; 21(9): 612-614, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31542907

RESUMO

BACKGROUND: Young women concerned about a breast cancer diagnosis will visit breast care centers and request breast cancer screening, including imaging studies, on their initial visit. OBJECTIVES: To explore the role of breast examination and breast ultrasound in self-referred asymptomatic women under the age of 40 years. METHODS: We identified 3524 women under the age of 40 at our medical clinic from 1 January 2010 until 1 June 2014. Of this group, 164 women with above average breast cancer risk were excluded and 233 were excluded because of breast complaints. Of 3127 women, 220 underwent breast ultrasound following the initial visit to the clinic and formed the study group. RESULTS: Of 220 women evaluated with ultrasound, 68 had prior positive clinical findings. Of this group 8 women had no sonographic findings, and in the remaining 60, a total of 30 simple cysts, 15 fibroadenomas, and 15 suspicious solid masses were identified. One infiltrating ductal carcinoma and one ductal carcinoma in situ were found in a biopsy. The remaining 152 of the 220 total women who underwent breast ultrasound without showing prior physical findings did not require follow-up. CONCLUSIONS: In the absence of clinical findings during physical breast examination, the addition of breast ultrasonography does not provide additional information to supplement the physical examination in self-referred women under age 40 who do not have any major risk factors for developing breast cancer.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/epidemiologia , Mamografia/estatística & dados numéricos , Ultrassonografia Mamária/estatística & dados numéricos , Adulto , Mama/diagnóstico por imagem , Feminino , Humanos , Israel/epidemiologia , Exame Físico/estatística & dados numéricos , Risco , Adulto Jovem
9.
Isr Med Assoc J ; 21(9): 595-598, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31542903

RESUMO

BACKGROUND: Adenovirus is responsible for 2-7% of childhood viral respiratory infections, 5-11% of viral pneumonia and bronchiolitis. Most are self-limited but may cause severe respiratory infection. OBJECTIVES: To describe adenovirus respiratory infection in immunocompetent children in a pediatric intensive care unit (PICU). METHODS: Children with adenovirus respiratory infection in our PICU from 2007 to 2016 were included. Data were retrospectively retrieved, including background, clinical manifestation, and treatment. Adenovirus was diagnosed by polymerase chain reaction, immune fluorescence, or both. RESULTS: Of 9397 samples, 956 were positive for adenovirus in children hospitalized during the study period. In total, 49 patients (aged 2 months-11.5 years) were admitted to our PICU, five were immunocompromised and excluded from the study, 19/44 (43%) were referred from other hospitals. Twenty-eight (64%) had underlying conditions, 66% had fever and cough, 11% had conjunctivitis, and 34% received antibiotics before admission. White blood cell counts ranged from 790 to 34,300 (mean 14,600) and 36% had counts above 15,000. Chest X-ray was consistent with viral infection in 77% of patients and normal in three (13.6%). Viral co-infection was found in 9 patients, 7 had presumed bacterial super-infection, and 27 (61.4%) needed mechanical ventilation. Two patients received cidofovir, 33 (75%) steroids, and 37 (84 %) antibiotics. Four patients died. CONCLUSIONS: Adenovirus respiratory infection may cause severe disease necessitating PICU admission and mechanical ventilation, mostly in patients with underlying conditions. Many patients received steroids and antibiotics, which may be unnecessary. Mortality was 9%, mainly among young infants and those with underlying conditions.


Assuntos
Adenoviridae/isolamento & purificação , Infecções por Adenovirus Humanos/epidemiologia , Hospedeiro Imunocomprometido , Unidades de Terapia Intensiva Pediátrica , Infecções Respiratórias/epidemiologia , Criança , Pré-Escolar , Comorbidade , Feminino , Humanos , Lactente , Israel/epidemiologia , Masculino , Estudos Retrospectivos
10.
Isr Med Assoc J ; 21(9): 599-602, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31542904

RESUMO

BACKGROUND: Ocular trauma in the pediatric population may lead to cataract formation. Managing traumatic cataracts in a visually immature child is a major challenge and can result in poor visual outcome. OBJECTIVES: To review our long-term surgical experience with childhood unilateral traumatic cataracts. METHODS: A retrospective observational study of children with unilateral traumatic cataracts with minimal follow-up of 5 years was conducted. Main outcomes included final visual acuity (VA) and occurrence of complications. RESULTS: Of the 18 children included in the study, 83% were male. Mean follow-up time was 12.5 years. Median age at injury was 7.5 years. Eleven patients (61%) presented with penetrating trauma injuries and 7 (39%) with blunt trauma. Sixteen patients (89%) had cataracts at presentation, while in two the cataracts developed during follow-up. Of the 18 total, cataract removal surgery was conducted in 16 (89%) with intraocular lens (IOL) implantation in 14 (87.5%), while 2 remained aphakic (12.5%). Two (11%) were treated conservatively. Long-term complications included IOL dislocation in 5 (36%), glaucoma in 8 (44%), and posterior capsular opacity in 10 (71%). No correlation was found between final visual acuity and the time interval between injury and IOL implantation nor between final VA and age at trauma. However, the final VA did correlate with time of follow-up. CONCLUSIONS: Severe complications occurred in over 30% of the patients during a long follow-up (mean 12.5 years). This finding shows the importance of discussions between the operating physician and the parents regarding the prognosis and necessity of scheduled follow-up.


Assuntos
Extração de Catarata/estatística & dados numéricos , Catarata/epidemiologia , Traumatismos Oculares/epidemiologia , Implante de Lente Intraocular/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Acuidade Visual , Adolescente , Causalidade , Criança , Pré-Escolar , Comorbidade , Traumatismos Oculares/cirurgia , Feminino , Seguimentos , Humanos , Israel/epidemiologia , Masculino , Estudos Retrospectivos , Tempo , Resultado do Tratamento
11.
Harefuah ; 158(8): 488-493, 2019 Aug.
Artigo em Hebraico | MEDLINE | ID: mdl-31407533

RESUMO

BACKGROUND: The aim of this study is to review motor-vehicle accident-related maxillofacial injuries (MVA-MFI) trauma cases and to investigate whether the growing population and traffic congestion, as well as differences in driving practice, vehicle safely devices and infrastructure facilities might differentially affect the pattern of MVA-MFI among Jewish and Arab populations. METHODS: This retrospective study reviews maxillofacial injuries (MFI) identified among all trauma patients who were admitted to Hadassah Ein Kerem hospital, Jerusalem, between the years 2000 to 2013. RESULTS: Out of 29,997 trauma patients, 1,720 presented with MFI, with motor-vehicle accident (MVA) being the major cause of injury (705 patients, 41%). Their mean age was 29.9±21.0 years with a prominent male and Jewish predominance (4.3:1 and 1.8:1, respectively). Most MVA-MFI casualties were car drivers (41%), followed by pedestrians (30%). Pedestrians with MVA-MFI were mainly children and aged persons, whereas drivers were mainly adults. Males and Arabs were more likely to present with higher injury severity score (ISS). Safety belts were not used in the majority of car MVA-MFI patients (54%). Yet, the ISS score did not correlate with the use of safety devices. Mandibular fractures were the most common (21%), followed by nasal bones (20%), zygoma (17%), orbit (16%), maxilla (15%) and teeth (11%). Age was significantly associated with increased maxillary and nasal fractures and with decreased incidence of mandibular and teeth fractures. DISCUSSION: Based on our review, young males and specifically Arab patients suffered from MFI and high ISS scores as a result of MVA. The findings and their interpretations are discussed.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Traumatismos Maxilofaciais/epidemiologia , Adolescente , Adulto , Idoso , Criança , Humanos , Escala de Gravidade do Ferimento , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Veículos Automotores , Estudos Retrospectivos , Adulto Jovem
12.
Isr Med Assoc J ; 21(6): 386-389, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31280506

RESUMO

BACKGROUND: Recently, studies have found that non-alcholic fatty liver disease (NAFLD) is associated with bacterial infections. Attempts to identify risk factors for recurrent urinary tract infections (rUTIs) are still underway. OBJECTIVES: To examine a possible association between NAFLD and rUTIs among premenopausal women. METHODS: In a case-control study, 1009 hospitalized premenopausal women with a UTI during a period of 3 years were retrospectively studied. A total of 186 subjects with rUTIs and 186 controls without a history of rUTIs were included in this study. Each participant had an abdominal ultrasonogram as part of the inclusion criteria. The two groups were compared in terms of risk factors for rUTIs, such as maternal history of rUTIs, use of contraceptives, frequency of sexual intercourse, metabolic syndrome, obesity, use of probiotics, serum levels of vitamin D, and NAFLD. An rUTI was defined as three or more episodes of UTI over a period of 1 year. NAFLD was diagnosed based on abdominal ultrasonography examination. RESULTS: Mean age of the 372 participants was 39.7 ± 5 years. NAFLD was diagnosed in 81/186 subjects (43.5%) with rUTIs vs. 40/186 controls (21.5%), P = 0.05. Women with rUTIs were more often obese and presented with lower serum levels of vitamin D than controls. Multivariate analysis showed that NAFLD (odds ratio = 1.6, 95% confidence interval 1.3-2.0, P = 0.04) were associated with rUTIs in premenopausal women. CONCLUSIONS: NAFLD was associated with rUTI in premenopausal women, independent of metabolic syndrome. Further studies are needed to confirm this association.


Assuntos
Síndrome Metabólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Pré-Menopausa , Infecções Urinárias/epidemiologia , Adulto , Estudos de Casos e Controles , Comorbidade , Feminino , Humanos , Israel/epidemiologia , Recidiva , Estudos Retrospectivos , Fatores de Risco
13.
Isr Med Assoc J ; 21(6): 399-403, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31280509

RESUMO

BACKGROUND: Hysterectomy is common in the management of symptomatic uterine prolapse. Vaginal wall repair is often necessary, for which vaginal mesh remains a popular option. OBJECTIVES: To evaluate the risk of mesh erosion following mesh-augmented vaginal prolapse repair, with or without concomitant vaginal hysterectomy. METHODS: This retrospective cohort comprised 70 women who underwent vaginal mesh-augmented pelvic organ prolapse repair from 2007 to 2010. Of the participants, 36 (51.4%) had a vaginal hysterectomy concomitant to the anterior and/or posterior vaginal mesh repair (hysterectomy group) and 34 (48.6%) underwent mesh repair without vaginal hysterectomy (no hysterectomy group). RESULTS: There were no inter-group differences in age, parity, menopausal state, hormonal use, or presenting symptoms. Previous prolapse repair surgery was much more common in the no hysterectomy group (29.4% vs. 5.5%, P = 0.01). Eleven patients (32.3%) in the no hysterectomy group had previously undergone hysterectomy. Anterior mesh repair was performed in 77.7% and 67.6% of hysterectomy and no hysterectomy patients, respectively. Posterior mesh repair was performed in 27.7% and 44.1%, respectively. One patient in the hysterectomy group underwent immediate removal of mesh due to infection. Surgically treated mesh erosion (limited local excision) occurred in three patients (8.3%) in the hysterectomy group (3, 16, and 18 months following surgery) and in two patients (5.8%) in the no hysterectomy group at 6 months following surgery (P = 0.67). CONCLUSIONS: Vaginal mesh-augmentation concomitant with vaginal hysterectomy for pelvic organ prolapse repair does not carry an increased risk of erosion.


Assuntos
Falha de Equipamento/estatística & dados numéricos , Histerectomia Vaginal , Prolapso de Órgão Pélvico/cirurgia , Complicações Pós-Operatórias/epidemiologia , Telas Cirúrgicas/efeitos adversos , Estudos de Coortes , Feminino , Humanos , Israel/epidemiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Risco
14.
Isr Med Assoc J ; 21(6): 381-385, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31280505

RESUMO

BACKGROUND: Malignancy is a known risk factor for venous thromboembolism; however, the association with arterial thromboembolic events remains unclear. OBJECTIVES: To examine the association between non-ST-elevation myocardial infarction (NSTEMI) and non-significant coronary artery disease (CAD) and the presence of new or occult malignancy. METHODS: An observational cohort, single-center study was performed 2010-2015. Adult patients with NSTEMI, who underwent coronary angiography and had no significant coronary lesion, were included. Using propensity score matching, we created a 2:1 matched control group of adults with NSTEMI, and significant coronary artery disease. Risk factors for new or occult malignancy were assessed using multivariate backward stepwise logistic regression analysis. The primary outcome was new or occult malignancy, defined as any malignancy diagnosed in the 3 months prior and 6 months following the myocardial infarction (MI). RESULTS: During the study period, 174 patients who presented with MI with non-obstructive coronary arteries were identified. The matched control group included 348 patients. There was no significant difference in the group demographics, past medical history, or clinical presentation. The incidence of new or occult malignancy in the study group was significantly higher (7/174, 4% vs. 3/348, 0.9%, P = 0.019). NSTEMI with non-significant CAD was an independent risk factor for occult malignancy (odds ratio [OR] 4.6, 95% confidence interval [95%CI] 1.1-18.7). Other risk factors included active smoking (OR 11.2, 95%CI 2.5-49.1) and age (OR 1.1, 95%CI 1.03-1.17). CONCLUSIONS: NSTEMI with non-significant CAD may be a presenting or early marker of malignancy and warrants further investigation.


Assuntos
Doença da Artéria Coronariana/epidemiologia , Neoplasias/epidemiologia , Infarto do Miocárdio sem Supradesnível do Segmento ST/epidemiologia , Estudos de Coortes , Comorbidade , Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco
15.
Harefuah ; 158(6): 352-356, 2019 Jun.
Artigo em Hebraico | MEDLINE | ID: mdl-31215185

RESUMO

BACKGROUND: Stroke is a leading cause of death and disability worldwide. Due to the high burden caused by stroke, the Israeli Ministry of Health initiated a national program for the treatment and prevention of stroke, including the establishment of an Israeli National Stroke Registry (INSR). In this article we will demonstrate the use of the INSR as a tool for monitoring the treatment of acute cerebrovascular events (stroke or transient ischemic attack). OBJECTIVES: 1. Assessing incidence rates of acute cerebrovascular events in Israel for the total population and by gender and ethnic group separately. 2. Presenting trends in a number of key indicators related to acute stroke care. METHODS: The INSR is based on data retrieval from hospital electronic medical records of all adult cases discharged with acute cerebrovascular diagnosis from January 1, 2014 on. Included in the current analysis were all cases reported to the INSR until June 31, 2017. RESULTS: The average annual incidence rate of cerebrovascular events in Israel was 3.2 cases per 1,000 people. Age-adjusted rates were significantly higher among Arabs, compared with the Jewish population. From 2014 to 2017 there was a moderate increase in the percentage of arrival by ambulance: from 43.2% to 49.0% and a significant increase in the percentage of head and neck vascular imaging performed: from 50.0% to 72.5%. Between 2014 and 2016 there was a significant increase in the percentage of t-PA administration, and in 2016-2017 the rates stabilized at 9.2%. The proportion of patients hospitalized in neurological wards was 38.0% - a slight increase from 35.0% in 2014. CONCLUSIONS: The INSR is an effective tool for monitoring morbidity and acute stroke care in Israel. Actions should be taken in order to raise public awareness of stroke warning signs and the establishment of stroke units with skilled multidisciplinary teams should become a priority. DISCUSSION: Compared with other western countries, rates of t-PA administration and arrival by ambulance in Israel are slightly low, rates of hospitalization in the neurological ward are significantly lower, and the lack of stroke units is most prominent.


Assuntos
Ataque Isquêmico Transitório , Sistema de Registros , Acidente Vascular Cerebral , Adulto , Humanos , Israel/epidemiologia , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia
16.
BMC Public Health ; 19(1): 715, 2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31238914

RESUMO

BACKGROUND: Cigarette smoking is a main cause of preventable morbidity and mortality. Many young adults begin smoking in the military, with smoking rates higher among soldiers than in the general population. Among other health effects, smoking impairs performance among soldiers. Smoking cessation programs in the military are challenging due to the unique settings and low access to smoking cessation resources. Studies have shown that text-messaging smoking cessation programs are feasible and effective, but there is a lack of studies on soldiers. OBJECTIVE: To evaluate the feasibility of a text-messaging smoking cessation program tailored for soldiers. METHODS: We recruited 81 soldiers who smoked, 76.5% of whom were male. Following enrollment, participants filled out a baseline survey and were given a text messaging program for 6 months. Participants could send predetermined keywords and immediately receive a response from a list of messages that were constructed as a response to the specific keyword. Participants filled out a follow-up survey at 1 month. Additionally, we retrieved and analyzed program usage data, including keywords sent and received, for the entire program period. Based on the follow-up survey and the program usage data, we assessed feasibility of the recruitment methods, participants' engagement and satisfaction and technical usability of the program. RESULTS: At 1 month, 20.6% reported that they had not smoked in the past week. A high percentage of the participants were engaged in the program, with 82.5% sending at least one valid keyword. The lowest self-efficacy group had higher chances of leaving the program (50.0%) while for the highest group there were much lower chances (4.8%). Most of the soldiers (96.8%) found the program easy to use and would recommend it to a friend (84.1%). CONCLUSIONS: The study demonstrates that a text-messaging smoking cessation program is feasible in a military setting. Further development and evaluation of digital smoking cessation tools tailored for soldiers are warranted.


Assuntos
Militares/psicologia , Abandono do Hábito de Fumar/métodos , Fumar/psicologia , Mensagem de Texto , Adolescente , Adulto , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Militares/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Fumar/epidemiologia , Inquéritos e Questionários , Adulto Jovem
17.
Med Oncol ; 36(7): 65, 2019 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-31165942

RESUMO

Malignancies of the salivary glands represent a multifarious disease. Evaluating the prognostic factors of these malignancies may help predict patient outcome and aid decision-making in choosing the most suitable therapy. We examined the role of various salivary tumorigenic, clinical and therapeutic features in a cohort of 101 patients diagnosed and treated for primary malignant salivary tumors. These include histo-pathological diagnosis, stage, grade and T, N, M values as well as the existence of perineural invasion and extra-parenchymal spread. We also identified the salivary gland involved, the sub-compartment specific location of the tumor and the therapy administered. All these were related to mortality. Of the 101 patients examined, 79 survived and 22 died due to the disease. Tumor staging, distant metastasis and perineural invasion were highly significant predictors of increased lethality. Histo-pathological grading was also a predictor but to a lesser degree. Neither neck metastasis nor tumor size or type had a significant impact on lethality. Performing neck dissections did not decrease lethality rate. Location of the tumor in the parotid gland and more so in its deep lobe adversely affected lethality; extra-parenchymal spread also had an adverse effect. Our results seem to indicate hematogenous rather than lymphogenous spread of metastasis from malignant salivary tumors. The highest therapeutic priority should be achieving full local control of the disease by safe removal of the primary salivary tumor, accompanied by regional control of perineural invasion and extra-parenchymal spread and appropriate systemic treatment aimed at eradicating distant metastasis.


Assuntos
Neoplasias das Glândulas Salivares/mortalidade , Humanos , Israel/epidemiologia , Estadiamento de Neoplasias , Neoplasias Parotídeas/mortalidade , Neoplasias Parotídeas/patologia , Neoplasias Parotídeas/terapia , Prognóstico , Neoplasias das Glândulas Salivares/patologia , Neoplasias das Glândulas Salivares/terapia
18.
BMC Public Health ; 19(1): 747, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196014

RESUMO

BACKGROUND: This study is the first to describe major epidemiological trends and clinical characteristics among Israeli men who have sex with men (MSM), who are at a higher risk for HIV infection. METHODS: This retrospective study includes all individuals reported to the Israeli Ministry of Health with HIV and self-identified as MSM between 1981 and 2015. The incidence rates of HIV infection and AIDS-defining diseases were analyzed and Kaplan-Meier survival estimates were calculated from time of HIV infection notification to AIDS diagnosis and death across three consecutive periods representing antiretroviral treatment availability. RESULTS: The trend of increase in HIV incidence is similar to Western Europe, although Israeli rates are lower. Of 2052 HIV/AIDS Israeli MSM diagnosed during the follow-up, 296 (14.6%) developed AIDS. MSM constitute 28.4% of all HIV/AIDS cases and 41.5% of cases among men. Average times from HIV-notification until AIDS diagnosis were 15.5 [14.0-16.9], 16.0 [15.5-16.4], and 6.7 [6.7-6.8] years, within 1981-1996, 1997-2007, and 2008-2015, respectively. The HIV-incidence rate among Israeli MSM slightly declined from 2012, after peaking in 2011 at 6.2 per 100,000. CONCLUSIONS: The recent reduction in HIV-incidence and in AIDS diagnoses among Israeli MSM is encouraging. Nevertheless, the disproportionate incidence of HIV among MSM requires sustained efforts to abate further infections.


Assuntos
Infecções por HIV/epidemiologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Incidência , Israel/epidemiologia , Masculino , Estudos Retrospectivos
19.
BMC Public Health ; 19(1): 738, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196053

RESUMO

BACKGROUND: Multimorbidity is associated with higher healthcare utilization; however, data exploring its association with readmission are scarce. We aimed to investigate which most important patterns of multimorbidity are associated with 30-day readmission. METHODS: We used a multinational retrospective cohort of 126,828 medical inpatients with multimorbidity defined as ≥2 chronic diseases. The primary and secondary outcomes were 30-day potentially avoidable readmission (PAR) and 30-day all-cause readmission (ACR), respectively. Only chronic diseases were included in the analyses. We presented the OR for readmission according to the number of diseases or body systems involved, and the combinations of diseases categories with the highest OR for readmission. RESULTS: Multimorbidity severity, assessed as number of chronic diseases or body systems involved, was strongly associated with PAR, and to a lesser extend with ACR. The strength of association steadily and linearly increased with each additional disease or body system involved. Patients with four body systems involved or nine diseases already had a more than doubled odds for PAR (OR 2.35, 95%CI 2.15-2.57, and OR 2.25, 95%CI 2.05-2.48, respectively). The combinations of diseases categories that were most strongly associated with PAR and ACR were chronic kidney disease with liver disease or chronic ulcer of skin, and hematological malignancy with esophageal disorders or mood disorders, respectively. CONCLUSIONS: Readmission was associated with the number of chronic diseases or body systems involved and with specific combinations of diseases categories. The number of body systems involved may be a particularly interesting measure of the risk for readmission in multimorbid patients.


Assuntos
Doença Crônica/epidemiologia , Multimorbidade/tendências , Readmissão do Paciente/estatística & dados numéricos , Idoso , Feminino , Humanos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Risco , Suíça/epidemiologia , Estados Unidos/epidemiologia
20.
Int J Gynaecol Obstet ; 146(3): 315-320, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31197830

RESUMO

OBJECTIVE: To compare pregnancy outcomes after exposure to military stress in different trimesters of pregnancy. METHODS: A retrospective study of medical records of deliveries in the Wolfson (WMC) and Barzilai (BMC) medical centers in Israel between July 2014 and April 2015. All parturients were exposed to military stress for 51 days during pregnancy. Pregnancy outcomes were compared between those exposed to military stress in the first or second trimester, and those exposed in the third trimester. Outcomes were also compared between WMC (a new-onset military stress exposure area) and BMC (a chronic military stress exposure area). RESULTS: At WMC, women exposed in the first or second trimester (n=2657) had a higher rate of preterm delivery (<37 weeks) as compared with those exposed in the third trimester (n=2037; 214 [8.1%] vs 121 [5.9%]; P=0.005). At BMC, women exposed in the first or second trimester (n=2208) had a tendency toward lower rates of diabetes mellitus (P=0.055) and macrosomia [103 (4.7%) vs 84 (6.3%); P=0.037], as compared with those exposed in the third trimester (n=1337). CONCLUSION: Exposure to military stress during pregnancy had different impacts on pregnancy outcomes, depending on the time of exposure and whether continuous exposure to stress occurred.


Assuntos
Exposição à Violência/psicologia , Complicações na Gravidez/psicologia , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Guerra/psicologia , Adulto , Parto Obstétrico/estatística & dados numéricos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Israel/epidemiologia , Gravidez , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Estudos Retrospectivos
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