Neonatal Direct Rigid Laryngoscopy and Bronchoscopy: A Near Miss

Airway management is a skill necessary for healthcare providers who manage patients. Intubation is a skill that both anesthesiologists and intensivists use daily. We present a case of a neonate that developed significant worsening stridor after a successful intubation for a hernia repair. After 4 intubation attempts, with easy visualization of the vocal cords and unsuccessful placement of the endotracheal tube, the patient was emergently brought to the operating room for evaluation.

Establishing an integrated gastroenterology service between a medical center and the community

AIM:To combine community and hospital services inorder to enable improvements in patient management,an integrated gastroenterology service(IGS)was established.METHODS:Referral patterns to specialist clinics were optimized;open access route for endoscopic procedures(including esophago-gastro-duodenoscopy,sigmoidoscopy and colonoscopy)was established;family physicians’knowledge and confidence were enhanced;direct communication lines between experts and primary care physicians were opened.Continuing education,guidelines and agreed instructions for referral were promoted by the IGS.Six quality indicators were developed by the Delphi method,rigorously designed and regularly monitored.Improvement was assessed by comparing 2010,2011 and 2012 indicators.RESULTS:An integrated delivery system in a specific medical field may provide a solution to a fragmented healthcare system impaired by a lack of coordination.In this paper we describe a new integrated gastroenterology service established in April 2010.Waiting time for procedures decreased:3 mo in April 30th 2010 to 3 wk in April 30th 2011and stayed between 1-3 wk till December 30th 2012.Average cost for patient’s visit decreased from 691 to638 NIS(a decrease of 7.6%).Six health indicators were improved significantly comparing 2010 to 2012,2.5%to 67.5%:Bone densitometry for patients with inflammatory bowel disease,preventive medications for high risk patients on aspirin/NSAIDs,colonoscopy following positive fecal occult blood test,gastroscopy in Barrett’s esophagus,documentation of family history of colorectal cancer,and colonoscopy in patients with a family history of colorectal cancer.CONCLUSION:Establishment of an IGS was found to effectively improve quality of care,while being costeffective.

Role of illness perception and self-efficacy in lifestyle modification among non-alcoholic fatty liver disease patients

To describe the relationships between non-alcoholic fatty-liver disease (NAFLD) patient’s disease consequences and treatment perceptions, self-efficacy, and healthy lifestyle maintenance.METHODSA cross-sectional study among 146 ultrasound diagnosed NAFLD patients who visited the fatty liver clinic at the Tel-Aviv Medical Center. Eighty-seven of these individuals, participated in a clinical trial of physical activity and underwent fasting blood tests, analyzed at the same lab. Exclusion criteria included positivity for serum HBsAg or anti-HCV antibodies; fatty liver suspected to be secondary to hepatotoxic drugs; excessive alcohol consumption (≥ 30 g/d in men or ≥ 20 g/d in women) and positive markers of genetic or immune-mediated liver diseases. Patients were asked to complete a self-report structured questionnaire, assembled by the Israeli Center for Disease Control. Nutrition habits were measured using six yes/no questions (0 = no, 1 = yes) adopted from the national survey questionnaire. Participants in the clinical trial completed a detailed semi-quantitative food frequency questionnaire (FFQ) reporting their habitual nutritional intake during the past year. Self-efficacy was assessed by the Self-Efficacy Scale questionnaire, emotional representation, degree of illness understanding, timeline perception, treatment perception and symptoms were measured by the Brief Illness Perception questionnaire. Illness consequences were measured by the Personal Models of Diabetes Interview questionnaire. A path analysis was performed to describe the interrelationships between the patients’ illness perceptions, and assess the extent to which the data fit a prediction of nutritional habits.RESULTSThe study sample included 54.1% men, with a mean age of 47.76 ± 11.68 years (range: 20-60) and mean body mass index of 31.56 ± 4.6. The average perceived nutrition habits score was 4.73 ± 1.45 on a scale between 0-6, where 6 represents the healthiest eating habits. Most of the study participants (57.2%) did not feel they fully understood what NAFLD is. Better nutritional habits were positively predicted by the degree of illness understanding (β = 0.26; P = 0.002) and self-efficacy (β = 0.25; P = 0.003). Perceptions of more severe illness consequences were related with higher emotional representation (β = 0.55; P < 0.001), which was related with lower self-efficacy (β = -0.17; P = 0.034). The perception of treatment effectiveness was positively related with self-efficacy (β = 0.32; P < 0.001). In accordance with the correlation between self-efficacy and the perceived nutrition habits score, self-efficacy was also correlated with nutrient intake evaluated by the FFQ; negatively with saturated fat (percent of saturated fat calories from total calories) (r = -0.28, P = 0.010) and positively with fiber (r = 0.22, P = 0.047) and vitamin C intake (r = 0.34, P = 0.002). In a sub analysis of the clinical trial participants, objectively measured compliance to physical activity regimen was positively correlated with the self-efficacy level (r = 0.34, P = 0.046).CONCLUSIONSelf-efficacy and illness understanding are major determinants of lifestyle-modification among NAFLD patients. This information can assist clinicians in improving compliance with lifestyle changes among these patients.

Vitamin D deficiency/insufficiency from childhood to adulthood:Insights from a sunny country

Vitamin D is known to be a key regulator of bone metabolism and is associated with muscle strength.Vitamin D deficiency is widely prevalent worldwide.In adults,vitamin D deficiency has been implicated in numerous health conditions including osteoporosis,cancer,diabetes,and autoimmune diseases.Considerable changes have occurred in lifestyles and childhood activities in the past years.Studies have shown that the children population is at high risks of vitamin D deficiency.The objective of this study was to learn about the extent of vitamin D deficiency in children worldwide and especially in sunny country like Israel.In this article we reviewed the extent and severity of vitamin D deficiency worldwide and especially in Israel,through a very comprehensive review of previous reports and research studies done during the last years.We found reports on vitamin D deficiency in children,which was associated with metabolic syndromes and obesity.It was more prevalent in children who spend less time on outdoor activities,in obese children,and in cases when there was imbalance between nutritional intakes and requirements.Vitamin D deficiency is common even in children living in sunny places like Israel.Health professionals should be aware of the fact that although vitamin D deficiency is prevalent in the elderly population,it is also common in children,and can be associated with different illnesses.We encourage supplementation of vitamin D to special populations(pregnant and lactating women,infants,and high risk groups).We also encourage implementation of international food fortification programs.

Effect of ezetimibe on the prevalence of cholelithiasis

AIM： To investigate the prevalence of cholelithiasis among patients treated with ezetimibe. METHODS： A retrospective, case-control study based on computerized medical records from patients of the Clalit Health Services, Sharon-Shomron region, from 2000 to 2009. Patients 20-85 years of age, who had been treated with ezetimibe and statins or statins only for at least 6 too, and who had an abdominal ultrasound were included in the study. Collected data included age, gender, ezetimibe treatment duration, presence of hypothyroidism or diabetes, and existence of cholelithiasis as determined by ultrasound. Ex- cluded were subjects after gallbladder resection, with hemolysis, myeloproliferative or inflammatory bowel diseases, and those treated with ursodeoxycholic acid and fibrates. Patients treated with statins and ezeti- mibe （study group） were compared to patients treated with statins only （control group）. RESULTS： The study group included 25 patients and the control group 168. All patients in the study were treated with statins. The study group included 13 males （52%） and 12 females （48%）, the control group 76 males （45%） and 92 （55%） females （P = 0.544）. The groups did not differ in age （mean age： 68 ± 8 years, range 53-85 years vs mean age： 71±8 years, range 51-85 years; P = 0.153） or in the rate of dia- betic and hypothyroid patients [11 （44%） vs 57 （33%）, P = 0.347 in the study group and 5 （20%） vs 23 （14%）, P = 0.449 in the control group, respectively]. Patients in the study group were treated with ezetimibe for an average of 798±379 d. Cholelithiasis was found in 4 （16%） patients in the study group and in 33 （20%） patients in the control group （P = 0.666）. CONCLUSION： Ezetimibe does not appear to influ- ence the prevalence of gallstones.

Literature review of type 2 diabetes mellitus among minority Muslim populations in Israel

This review surveys the literature published on the characteristics and implications of pre-diabetes and type 2 diabetes mellitus(T2DM) for the Arab andBedouin populations of Israel. T2 DM is a global health problem. The rapid rise in its prevalence in the Arab and Bedouin populations in Israel is responsible for their lower life expectancy compared to Israeli Jews. The increased prevalence of T2 DM corresponds to increased rates of obesity in these populations. A major risk group is adult Arab women aged 55-64 years. In this group obesity reaches 70%. There are several genetic and nutritional explanations for this increase. We found high hospitalization rates for micro and macrovascular complications among diabetic patients of Arab and Bedouin origin. Despite the high prevalence of diabetes and its negative health implications, there is evidence that care and counseling relating to nutrition, physical activity and self-examination of the feet are unsatisfactory. Economic difficulties are frequently cited as the reason for inadequate medical care. Other proposed reasons include faith in traditional therapy and misconceptions about drugs and their side effects. In Israel, the quality indicators program is based on one of the world's leading information systems and deals with the management of chronic diseases such as diabetes. The program's baseline data pointed to health inequality between minority populations and the general population in several areas, including monitoring and control of diabetes. Based on these data, a pilot intervention program was planned, aimed at minority populations. This program led to a decrease in inequality and served as the basis for a broader, more comprehensive intervention that has entered the implementation stage. Interventions that were shown to be effective in other Arabic countries may serve as models for diabetes management in the Arab and Bedouin populations in Israel.

Nutritional deficiencies in the pediatric age group in a multicultural developed country,Israel

Nutrient deficiencies are prevalent worldwide.Diseases and morbid conditions have been described to result from nutritional deficiencies.It is essential to address nutrient deficiencies as these may lead to chronic longterm health problems such as rickets,iron deficiency anemia,goiter,obesity,coronary heart disease,type2 diabetes,stroke,cancer and osteoporosis.In the present review we surveyed the extent and severity of nutritional deficiencies in Israel through a selective and comprehensive Medline review of previous reports and studies performed during the last 40 years.Israel populations have multiple nutritional deficiencies,including iron,calcium,zinc,folic acid,and vitamins B12,C,D and E,spanning all age groups,several minorities,and specific regions.In Israel,some of the nutrients are mandatorily implemented and many of them are implemented voluntarily by local industries.We suggest ways to prevent and treat the nutritional deficiencies,as a step to promote food fortification in Israel.

Necessity for Vitamin D Screening among Urban Bedouin Women of Childbearing Age

Vitamin D (Vit D) plays multiple roles in bodily functions. Vit D deficiency is a common, but often under-diagnosed condition with possible serious complications. According to some research, Vit D is important particularly among women and children. No data were found concerning the Vit D status among urban Bedouin women of childbearing age. The research study is retrospective and descriptive. We analyzed 202 medical histories of patients undergoing blood tests for Vit D level for various reasons. The main objectives of the research were: 1) determining the prevalence of the Vit D deficiency among the Bedouin women of childbearing age;2) identifying the causes for the physicians’ reasons for suspecting Vit D deficiency: the complaints or symptoms which cause the doctor to test for Vit D level. As a result, in 80.7% of those tested for Vit D, levels were less than 10 ng/ml, and in 19.3%, levels of 10 to 20 ng/ml were found. In lieu of our findings and in order to prevent serious health problems, Vit D screening plan should be seriously considered and discussed in the Bedouin population with high risk of deficiency.

The Effect of Maternal Mathematical Activities on the Fetal Brain

Background: In recent years, there has been growing interest in the effect of maternal exposure to physiological, environmental, and also psychological factors during gestation on child development. Several independent studies link maternal stress during pregnancy to emotional and behavioral problems in the child. Objectives: This study aimed to observe the effect of maternal cognitive activity on fetal brain blood flow to determine whether systematic maternal mathematical activity during pregnancy might influence child brain development. Method: Thirty-five women in the 28th to 40th week of pregnancy engaged in mathematical activities. Fetal middle cerebral artery (MCA), pulsatility index (PI) and peak systolic velocity (PSV) were monitored before, during, and after the activity. Results: Brain activity and blood flow were shown to be intimately linked. We observed a significant decrease in fetal brain MCA resistance, as evidenced by decreased MCA PI, towards the end of the mathematical activity. This may result in increased blood flow in the arteries supplying most brain regions and, possibly, increased brain activity. Conclusions: A correlation between the mother’s engagement in mathematical activities and fetal brain blood flow may lead to enhancement of the fetus’s brain function and a cognitive advantage for the child.

Participation in Daily Activities among Working Women Following Breast Cancer

Introduction: This study aimed to identify the variables explaining retained activity level for working women with breast cancer;the variables correlating with their performance in daily activities they prioritize;and factors facilitating or restricting their return to work. Method: Sixty working women with breast cancer aged 25 - 65 years completed a personal data questionnaire, the modified Activity Card Sort, the Canadian Occupational Performance Measure;and two open- ended questions about facilitators and barriers to work. Results: Activity levels dropped by a quarter following BC treatments. Most women (67%) decreased their weekly working hours, although a third identified work as their highest priority. A higher total retained activity level was explained by fewer limitations on the range of motion (upper extremity), age younger than 45 years, and higher educational attainment. Cognitive limitations and limited range of motion negatively correlated with retained activity level at work. Personal and disease factors, job demands, and environmental factors facilitated or restricted return to work. Conclusion: Interventions should focus on physical and cognitive rehabilitation to regain functioning in the context of work and productive daily activities. Special attention should be paid to the greater needs of younger women.

Neck Motion Restriction Negatively Affects Turning Stability in Community-Dwelling Older Adults with and without a History of Falls

Background: Many older adults fall while turning. During the turning maneuver, rotation of the head precedes the rest of the body, creating a spatial frame of reference. Limitations of the neck rotation, may interfere with the turning mechanism, affect stability, and lead to recurrent falls. However, the association between the range of the neck rotation and turning stability was not explored yet. Purpose: To compare the impact of restricting the neck rotation by a brace, on the turning stability of adults with and without a history of falls. Methods: An observational, cross-sectional study consisting of 59 adults (average age 76 ± 6.9). A group (N = 29) with at least 2 falls (FL) in the last year and a group (N = 30) without a history of falls in the last year (NFL). All participants performed three tests: Timed up and Go (TUG), 180° Turn Test (180 TT) and 360° Turn Test (360 TT) with and without a neck brace. Results: All the scores of the FL were lower than those of the NFL (p Application of the brace worsened the performance of the 180 TT and the 360 TT of both groups (p < 0.05) but there was no interaction between group and bracing. The TUG score of only the NFL was affected by the brace (p < 0.004). Interestingly, only the range of the right neck rotation was correlated with balance tests and number of falls (r = 0.272;p Conclusions: Restricting of the neck mobility worsened the turning stability of both groups but without interaction. The study reinforces the need of considering the neck range of motion when addressing adult stability. A decrease in the range of right neck rotation was identified as a risk factor for loss of balance.

以色列士兵足癣的患病率和危险因素

Background: Tinea pedis is a common infection in soldiers. However, prevalence and risk factors for tinea pedis in soldiers were investigated in only a few studies. Objectives: To investigate the prevalence and risk factors for tinea pedis in Israeli soldiers. Methods: A cross-sectional study including interviews, clinical skin examination and mycological tests was performed in Israeli soldiers. The presence of tinea pedis was assessed using the Athlete s Foot Severity Index (AFSI), a scoring system that was developed in order to evaluate the presence and severity of tinea pedis. In soldiers with clinical evidence of tinea pedis (AFSI > 1), scrapings were taken for direct microscopic examination (20% KOH preparation) and fungal culture. Statistical analyses were performed using chi-square or Fisher s exact test for dichotomous variables (as needed), or t-tests for continuous variables. Logistic regression was used for multivariate analyses of dichotomous variables. Results: Two hundred and twenty-three soldiers were included in the study: 205 men (91.9% ) and 18 women (8.1% ). Mean age was 19.6 years (SD 1.0 year). Clinical point prevalence was 60.1% . Mycological point prevalence was 27.3% . Further analyses were performed using the clinical point prevalence. Univariate analyses demonstrated that the prevalence of tinea pedis varied with the setting of military training (basic training: 70.3% , advanced infantry training: 81.5% , armor commander training: 56.4% and armor officer training: 34.8% ) and was associated with male gender, frequency of sock changes and the length of military service. A multivariate analysis demonstrated that tinea pedis was associated with the setting of the military training (OR 1.6, 95% Cl 1.2- 2.1) and male gender (OR 4.3, 95% Cl 1.4- 13.8); however, there was no association with hygiene measures (e.g. frequency of changing socks or sleeping with socks) or the length of military service. Conclusion: Tinea pedis is highly prevalent in Israeli soldiers. Association of tinea pedis with the setting of military training suggests that contagious spread may be an important risk factor. We suggest that environmental interventions should be planned to in order to decrease the morbidity of tinea pedis among soldiers.

The Healthcare of the Final Frontier- Comprehensive Epidemiological Approach to the Future of Human Space Exploration and Travel

Today,the discussion about colonizing different planets has shifted from the"IF"mode to the"WHEN"mode,and the substantial large group of humans living for a long time in an isolated,hostile,and enclosed environment is about to become a reality.Thus,the space-related healthcare methodologies should shift as well from a small number of selected persons to much more extensive groups with much less health homogeneity.Moreover,the development of human colonies,first on the Moon and later on Mars,will be a game changer in allthat we know and use to see in space travel and eventually in space health.Humans will leave Earth but will carry human society's health patterns,adjusted to the environment.The foundation for space epidemiology modeling can be set today and should attract the attention of the epidemiological and space research communities.

Rare Aggressive Form of Multiple Myeloma with Diffuse Osteosclerosis and Elevated CA 15-3 Levels

We report the case of a 56-year-old female who had recently been examined for back and epigastric pain, and was diagnosed in the internal medicine ward as having an aggressive rare form of multiple myeloma with diffuse osteoblastic bone lesions. She also had high levels of breast tumor marker (CA 15-3), severe tumor lysis syndrome, and pleural and central nervous system involvement. A few cases of multiple myeloma with diffuse osteosclerosis that are not part of POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin changeshave) have been described. None of these cases were as aggressive as our case. To our knowledge it is the first report describing an elevation in CA 15-3 in conjunction with multiple myeloma.

Efficacy and tolerability of a polysaccharide-resin-honey based cough syrup as compared to carbocysteine syrup for children with colds: a randomized, single-blinded,multicenter study

Background:Available pediatric treatments for acute cough are limited by lack of demonstrated efficacy.The objective of this trial is to compare the effects of a poIysaccharide—resin-honey based cough syrup,and carbocysteine syrups on nocturnal and daytime cough associated with childhood upper respiratory tract infections(URIs).

A new algorithm for the diagnosis of celiac disease

Celiac disease(CD)affects at least 1%of the Western population but remains largely unrecognized.In our laboratory,we utilize a novel algorithm to diagnose pediatric CD that offers both high sensitivity and high specificity for diagnosis in an outpatient setting.The aim of the present study was to challenge this algorithm and to test its performance in children and adults suspected of having CD.Using a three-assay algorithm,screening with the most sensitive tissue transglutaminase(tTG)complexed with deamidated gliadin peptide neoepitope immunoglobulin A(IgA)1IgG assay and confirming with the two specific tTG IgA and tTG IgA1IgG assays,we examined the serological results from 112 children aged 0–17 years old and 60 adults in comparison to their respective biopsy results.The algorithm performance was calculated by statistical analysis.The use of the new algorithm enabled us to diagnose CD with 98%sensitivity,93%specificity and 95%accuracy in the pediatric group and 94%sensitivity,92%specificity and 93%accuracy in the total population studied.The false-negative cases in the adult group were attributed to previous adherence to a gluten-free diet,and the single false-negative result in a young child became a true positive after 6 months.We have also monitored three celiac patients before and after diagnosis and found that the algorithm may be suitable for disease monitoring.The newly proposed three-assay algorithm for celiac detection is very reliable in both children and adults.Due to the high performance of this assay,the further need for confirmatory intestinal biopsies will be reassessed.