Harefuah最新文献

Introduction: ULCERATIVE COLITIS AND PRIMARY SCLEROSING CHOLANGITIS.

Introduction: "Digital Health" includes a variety of health services delivered through technological means, such as: booking an appointment, talking to a doctor, viewing personal information and more. The use of digital services in Clalit Health Services (CHS) clinics in the Bedouin sector is low compared to the general sector.

Objectives: To examine the usage of digital services, the characteristics of users, and the barriers to use it among patients from the Bedouin sector at the Segev Shalom Clinic of CHS.

Methods: A cross-sectional study among visitors to the CHS Segev Shalom clinic, aged 18-65 years during the period 17.05.2023-31.05.2023). The clinic's members belong to the Bedouin sector and have a low socioeconomic level. About 50% of the clinic's members live around the settlement of Segev Shalom. The visitors were interviewed using a structured research questionnaire that examined the use and barriers to use of telehealth services among the Arab population in Israel.

Results: A total of 196 clinic visitors were interviewed. Of these, 37.3% were males, average age 34.5±11.2 years and 58% live in a permanent settlement. About 44% of the respondents do not book a doctor appointment in advance but come to the clinic when necessary; 38.8% book an appointment by phone, and only 16.8% book an appointment through digital services. The main reason for not using digital services (80.5% of respondents) was lack of knowledge on how to use the service. In a logistic regression model for predicting patients who will not make a doctor's appointment in advance, it was found that the influential factors are: gender (male) (OR=1.92, (p=0.04), age in years (OR=1.03, p=0.01), little/very little consent that fast service can be obtained via digital services (OR=2.24, p=0.02) and smartphone ownership (OR=0.08, p=0.02).

Conclusions: Among the study population, there is a lack of awareness of digital services and a lack of knowledge of its operation. Work should be taken to raise awareness and knowledge in a variety of ways at the clinic level, the community level and the sector level.

Introduction: Allergic fungal rhinosinusitis is a subtype of chronic rhinosinusitis. It is characterized by an allergic reaction to non-invasive fungal infections causing severe inflammation and accumulation of thick mucin rich with eosinophils and fungi hyphae within the sinuses. This subset accounts for 8% of all chronic rhinosinusitis cases worldwide. The criteria for diagnosis include chronic rhinosinusitis, eosinophilic mucin on pathology, allergic reaction to fungi, lack of invasive fungal disease or immunodeficiency and characteristic hyperdense secretions seen on computed tomography. The mainstay therapy is endoscopic sinus surgery, which can be more challenging than that for chronic rhinosinusitis with higher rates of complications. Pre-operative systemic steroids and post-operative maintenance with saline irrigations and local nasal steroids are imperative for successful treatment.

Introduction: Chronic subdural hemorrhage (CSDH) is one of the most common reasons for neurosurgical intervention. The incidence and prevalence of this condition is expected to grow due to aging of the population and the increase in anticoagulation and anti-aggregation prescription drugs. Traditionally, it was accepted that the bleeding originates from bridging veins that drain the brain towards the dural sinuses. However, recent findings exposed an additional underlying mechanism. Trauma leads to separation of the dural border cell layer which induces an inflammatory process that starts positive feedback of leaky blood vessels formation (angidysgensis), which causes blood product leakage that further increases the inflammation. For many years, the disease has been treated conservatively in cases of mild clinical and imaging features, or by surgical evacuation of the hematoma in more severe cases. The literature shows a consistent high recurrence rate of around 30% following a surgical removal of the blood. The newly discovered mechanism inspired the development of a novel treatment method for this entity. Endovascular embolization of the middle meningeal artery (MMA). This method has an excellent efficacy and safety profile, and it can be performed alone or in combination with surgical evacuation. This review presents the epidemiology and mechanisms underlying CSDH, in addition to possible treatment methods, and eventually discuss MMA embolization to increase the awareness of the medical community in Israel to this new approach.

Introduction: The article delves into the broader applications of genomic and molecular identification beyond medicine, highlighting its use in areas such as transplantation, identification of genetic diseases, fertility treatments and personalized medicine. Moreover, genomic identification serves as a powerful tool in fields such as paternity testing, inheritance law, genealogy, immigration, forensic identification and post-mortem identification. The process of post-mortem human identifications, on any scale-including in extreme events like wars and mass casualty incidents-is a crucial part of the investigative efforts. This process is protected by international conventions to prevent prolonged grief and uncertainty, ultimately leading to "closure" regarding the fate of the victims. In recent years, there have been significant advancements in biometric genomic identification technologies as part of the broader development of forensic pathology. These advances are based on research and discoveries in genetics, as well as innovations in genomic sequencing technologies and biomedical equipment classified as "lab-on-a-chip" technologies. The developments in genomic identification are happening alongside overall progress in biometric identification and the growing need for rapid genomic-biometric identification, particularly in mass casualty and extreme events.

Introduction: Post-orgasmic Illness Syndrome (POIS) is an uncommon condition characterized by the emergence of flu-like and allergy-like symptoms following ejaculation, lasting for a period of 2 to 7 days. The syndrome presents in two primary age-related onset patterns: one during puberty and another initiating later in adult life. Although the condition leads to significant emotional distress and a decline in quality of life, its true prevalence remains elusive due to underreporting and underdiagnosis. The leading etiological hypothesis suggests an immunological mechanism, specifically an allergic reaction to the patient's own sperm. A handful of studies support this hypothesis, providing compelling evidence that hyposensitization treatment using autologous sperm effectively alleviates the symptoms of POIS. This suggests that an immune response against sperm components may be the primary underlying cause. However, a definitive understanding of the syndrome's pathophysiology requires further investigation.

Introduction: Trauma is a common life event, and sexual abuse is a common traumatic event. Consequences of trauma on health are extensive, and the relationship between childhood trauma and impaired health later in life is well-established. Health-care providers routinely encounter trauma survivors, and often lack confidence and training in trauma-informed care (TIC). TIC is an approach that acknowledges the high prevalence of trauma, assesses its impact on survivors, addresses the trauma, and strengthens the victims by providing professional support. TIC guiding principles include offering patients control over their own body and health, implementing routine screening for past traumatic events, adopting an open and supportive body language, creating transparency and cooperation, and refraining from an authoritarian approach.

Introduction: Li-Fraumeni syndrome is a rare genetic disorder caused by a mutation in the TP53 gene. The syndrome is characterized by a variety of malignancies that manifest in early childhood. In this article, we present a young patient diagnosed with Li-Fraumeni syndrome following recurrent rhabdomyosarcoma. A personalized literature search was performed to identify novel therapeutics that may be appropriate for this patient. In the absence of randomized, double-blind studies, the relevance of each potential treatment was evaluated using the Bradford-Hill criteria. These criteria underlie the medical logic used for assessing causation. This case was then used to explore the ability of the large language model ChatGPT to conduct a similar review and assess its treatment suggestions using the Bradford-Hill criteria. In-depth exploration suggested that ChatGPT treatment suggestions based solely on the presentation of the case and a general question are insufficiently informative. Targeted prompts (instructions for structuring the response, formulated as questions) lead to the generation of more accurate and clinically useful model responses but these, too, should be approached with caution.

Introduction: Twin pregnancies are associated with a high incidence of fetal structural and genetic malformations. Early detection will improve pregnancy outcomes and offer early intervention when necessary.

Methods: A prospective, observational study in twin pregnancies, including multiple sonographic scans at different gestational ages to identify fetal structural anomalies.

Results: We enrolled 120 women (240 fetuses) with di- or mono-chorionic live twins. All fetuses had an anomaly scan performed in the first, early (13+6-17+6gestational weeks), second, and third trimester. A total of 15 significant structural anomalies were identified. Five anomalies (33%) were identified in the first trimester, another 5 cases (33%) were identified in the early scan, an additional 3 (20%) at the second-trimester scan, and finally, two more (12.3%) were identified in the third-trimester scan. A total of 6 fetuses demised spontaneously. Four fetuses were reduced. Two women (4 fetuses) left the study. Altogether, 216 fetuses were delivered, and no anomaly was identified post-partum.

Conclusions: In twin pregnancies, the unification of the nuchal and the early anomaly scan in the first trimester and the performance of the second and third-trimester scans will result in the identification of most fetal malformations without added cost. We recommend the performance of three anomaly scans, one in each trimester. Our conclusion should be confirmed in a larger cohort.

Discussion: Over 86% of significant prenatal structural anomalies were identified until the midst of pregnancy. A model of three complete anomaly scans, one in every trimester, is proposed. Our experience allowed us to identify all the anomalies at a similar cost to the current model of four scans (including first-trimester NT and third-trimester weight assessment).

Introduction: Childhood exposure to violence and abuse has a long-term effect on physical and mental health. Recent research shed light on the connection between childhood maltreatment and an increase in chronic physical morbidity later in life. In this narrative review, we sought to look at this relationship through a gender lens. One major difference between genders is the nature of insults, whereas sexual abuse and chronic insults are more common among girls compared to boys. These differences manifest clinically during adulthood, and provide another explanation for the differences in epidemiology, pathophysiology, and clinical manifestations among women and men. In this review, we will demonstrate the connection between exposure to violence at a young age and the development of diseases according to body systems, including the immune, cardiovascular, respiratory, digestive and neurologic systems. The gender perspective can be found not only in the clinical and epidemiological fields, but also in basic sciences. In the last decade, new technological developments have made it possible to identify mechanisms that explain the clinical connection between early exposure to violence and chronic morbidity. Sex-dependent characteristics have been found when researching epigenetic changes, structural and functional changes in the central nervous system, disturbances in autonomic regulation and endocrine effects. We hope that this review will contribute to a multidimensional understanding of some overlooked risk factors for common chronic diseases and will open a new frontier for preventive medicine and early intervention.