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Eosinophil Cell Count Predicts Mortality in the Intensive Care Unit after Return of Spontaneous Circulation. 嗜酸性细胞计数预测重症监护病房自然循环恢复后的死亡率。
IF 1.5 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2022-01-27 DOI: 10.5041/RMMJ.10458
İlhan Korkmaz, Yusuf Kenan Tekin, Gülaçan Tekin, Erdal Demirtaş, Sefa Yurtbay, Naim Nur

Background: Eosinophils constitute 1%-5% of peripheral blood leukocytes, less in the presence of acute infections (referred to as eosinopenia). Studies indicate that eosinopenia can be used as a prognostic predictor for chronic obstructive pulmonary disease exacerbation, sepsis, or acute myocardial infarction disease. There are only a few studies about predicting mortality in emergency departments and intensive care units (ICUs). Prognostic studies about patients in ICUs are generally carried out using different scoring systems. We aimed to analyze if the eosinophil count can estimate the prognosis among non-traumatic patients who underwent cardiopulmonary resuscitation and were hospitalized in ICU thereafter.

Methods: The data were evaluated of 865 non-traumatic adult patients (>18 years of age) who were admitted with cardiopulmonary arrest or developed cardiopulmonary arrest during clinical follow-ups. Admission venous blood sample tests, complete blood count, and biochemical laboratory results were recorded. Arterial blood gas results were also evaluated. The mean results of the recorded laboratory results were compared between the surviving and non-surviving patients groups.

Results: There was a significant difference between the two groups in regard to platelet, eosinophil count, pH, PaO2, SaO2, and HCO3- (P<0.001 for all). In the multiple linear regression analysis, eosinophil counts were found to be an independent factor (odds ratio=0.03, 95% confidence interval 0.33-0.56, P<0.001) associated with the mortality after cardiopulmonary resuscitation.

Conclusion: Because admission eosinophil counts can be measured easily, they are inexpensive biomarkers that can be used for predicting the prognosis among the patients who have return of spontaneous circulation and are treated in ICUs.

背景:嗜酸性粒细胞占外周血白细胞的1%-5%,急性感染时较少(称为嗜酸性粒细胞减少)。研究表明,红细胞减少可作为慢性阻塞性肺疾病加重、败血症或急性心肌梗死疾病的预后预测因子。关于预测急诊科和重症监护病房(icu)死亡率的研究很少。icu患者的预后研究通常采用不同的评分系统。我们的目的是分析嗜酸性粒细胞计数是否可以估计非创伤性患者的预后,这些患者接受了心肺复苏并在ICU住院。方法:对865例在临床随访中出现心肺骤停或出现心肺骤停的非创伤性成人患者(>18岁)进行资料分析。记录入院静脉血化验、全血细胞计数及生化化验结果。动脉血气结果也进行了评估。比较存活组和非存活组的平均实验室结果。结果:两组患者血小板、嗜酸性粒细胞计数、pH、PaO2、SaO2、HCO3- (p)差异有统计学意义。结论:入院时嗜酸性粒细胞计数测量简便,是一种廉价的生物标志物,可用于预测icu患者自然循环恢复后的预后。
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引用次数: 0
Response to Letter to the Editor: "First Admission Neutrophil-Lymphocyte Ratio May Indicate Acute Prognosis of Ischemic Stroke". 致编辑的回复:“首次入院中性粒细胞-淋巴细胞比率可能指示缺血性卒中的急性预后”。
IF 1.5 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2021-10-25 DOI: 10.5041/RMMJ.10457
Murat Alpua, Bahar Say, Ilknur Yardimci, Ufuk Ergün, Ucler Kisa, Ozlem Doğan Ceylan
We have carefully read and evaluated the letter writ¬ten by Drs Mungmunpuntipantip and Wiwanitkit regarding our article published in the July issue of Rambam Maimonides Medical Journal.
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引用次数: 0
Teaching Shared Decision Making to Undergraduate Medical Students. 医学本科学生共同决策教学
IF 1.5 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2021-10-25 DOI: 10.5041/RMMJ.10453
Meira Tidhar, Jochanan Benbassat

Despite the wide endorsement of shared decision making (SDM), its integration into clinical practice has been slow. In this paper, we suggest that this integration may be promoted by teaching SDM not only to residents and practicing physicians, but also to undergraduate medical students. The proposed teaching approach assumes that SDM requires effective doctor-patient communication; that such communication requires empathy; and that the doctor's empathy requires an ability to identify the patient's concerns. Therefore, we suggest shifting the focus of teaching SDM from how to convey health-related information to patients, to how to gain an insight into their concerns. In addition, we suggest subdividing SDM training into smaller, sequentially taught units, in order to help learners to elucidate the patient's preferred role in decisions about her/his care, match the patient's preferred involvement in these decisions, present choices, discuss uncertainty, and encourage patients to obtain a second opinion.

尽管共享决策(SDM)得到了广泛的认可,但其融入临床实践的速度很慢。在本文中,我们建议通过对住院医师和执业医师的SDM教学,以及对本科医学生的SDM教学来促进这种整合。所提出的教学方法假设SDM需要有效的医患沟通;这种交流需要移情;医生的同理心需要能够识别病人的担忧。因此,我们建议将教学SDM的重点从如何向患者传达健康相关信息转移到如何深入了解他们的关注点。此外,我们建议将SDM训练细分为更小的、顺序教学的单元,以帮助学习者阐明患者在关于她/他的护理决策中的首选角色,匹配患者在这些决策中的首选参与,提出选择,讨论不确定性,并鼓励患者获得第二意见。
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引用次数: 4
Loneliness, Depression, and Anxiety Experienced by the Israeli Population During the First COVID-19 Lockdown: A Cross-sectional Survey. 以色列人口在第一次COVID-19封锁期间经历的孤独、抑郁和焦虑:一项横断面调查。
IF 1.5 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2021-10-25 DOI: 10.5041/RMMJ.10449
Jason Brafman, Robert Lubin, Revital Naor-Ziv, Sarah Rosenberg, Tzvi Dwolatzky
This research letter presents our study, which sought to evaluate the differences in the prevalence of self-reported symptoms of depression, anxiety, and loneliness between younger and older generations at the time of the COVID-19 pandemic. Since the younger generation is generally less accustomed to facing and dealing with adversity and illness, we hypothesized that adolescents and younger adults would have a higher prevalence of depression, anxiety, and loneliness as compared to the older generation. It must be emphasized that this survey was conducted during the first COVID-19 lockdown that occurred in Israel from mid-March 2020 to early May 2020. This was a time when businesses were closed, individuals and families were isolated at home with very limited social contact, and feelings of fear and panic were fueled by the electronic media.
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引用次数: 3
Factors Associated with Catch-up Growth in Term, Asymmetrical Small-for-Gestational Age Infants in the First Year of Life. 与足月追赶型生长有关的因素,出生第一年不对称的小胎龄婴儿。
IF 1.5 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2021-10-25 DOI: 10.5041/RMMJ.10452
Sundar Sivakumar, Thasma Santhanakrishnan Arunprasath, Padmasani Venkat Ramanan

Introduction: Catch-up growth (CUG) in small-for-gestational age (SGA) infants is essential for their overall development. Knowledge about the factors influencing CUG might be critical in their effective management. Hence this study was performed with the aim of identifying factors that may influence CUG in SGA infants.

Methods: Asymmetrical SGA infants born at term were included in the study as per defined criteria, and their demographic details were recorded. Anthropometric data, feeding practice details, and intercurrent illnesses data were collected on follow-up at 6 weeks, 6 months, and 12-15 months of age. Catch-up growth weight was defined as improvement of weight to the normal range of -2 to +2 weight-for-age Z score (WAZ). Analysis was carried out using SPSS Expand 17 software. Chi-square test was used to find association between variables. Logistic regression analysis was used to measure effect. A P value of less than 0.05 was taken as significant.

Results: Out of 324 SGA infants born at term, 119 completed 12-15-month follow-up, of which 69.7% had achieved CUG weight. Exclusive breastfeeding >4 months, continued breastfeeding until 12-15 months, and absence of diarrheal episodes were positively associated with CUG. Pregnancy-induced hypertension, gestational diabetes, and maternal overweight/obesity were negatively associated with CUG. Maternal education status, conception age, gravida status, mode of delivery, vitamin D and iron supplementation, and intercurrent respiratory infections were not associated with CUG. On multivariate analysis, continued breastfeeding and absence of diarrheal episodes were independent factors associated with CUG.

Conclusion: Breastfeeding practice, especially continued breastfeeding, and the absence of diarrheal illness are the key determinants for achieving CUG weight in term SGA infants, particularly in settings where resources are limited.

小胎龄(SGA)婴儿的追赶生长(CUG)对其整体发育至关重要。了解影响CUG的因素对其有效管理可能是至关重要的。因此,本研究的目的是确定可能影响SGA婴儿CUG的因素。方法:将足月出生的不对称SGA婴儿按定义的标准纳入研究,并记录其人口统计学细节。在6周、6个月和12-15个月的随访中收集人体测量数据、喂养方法细节和并发疾病数据。追赶生长体重定义为体重改善到-2 ~ +2年龄体重Z分数(WAZ)的正常范围。采用SPSS Expand 17软件进行分析。使用卡方检验来发现变量之间的相关性。采用Logistic回归分析测量效果。P值小于0.05为显著性。结果:324例足月出生的SGA患儿中,有119例完成了12-15个月的随访,其中69.7%达到了CUG体重。纯母乳喂养>4个月,持续母乳喂养至12-15个月,没有腹泻发作与CUG呈正相关。妊娠高血压、妊娠期糖尿病和孕妇超重/肥胖与CUG呈负相关。产妇受教育程度、受孕年龄、妊娠状况、分娩方式、维生素D和铁的补充情况以及并发呼吸道感染与CUG无关。在多变量分析中,持续母乳喂养和没有腹泻发作是与CUG相关的独立因素。结论:母乳喂养实践,特别是持续母乳喂养,以及没有腹泻疾病是足月SGA婴儿达到CUG体重的关键决定因素,特别是在资源有限的环境中。
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引用次数: 1
Deep Epicardial Laceration after Cardiopulmonary Resuscitation: A Case Report. 心肺复苏后深心外膜撕裂1例。
IF 1.5 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2021-10-25 DOI: 10.5041/RMMJ.10455
Noa Fried Regev, Tzachi Slutsky, Oren Lev-Ran, Yaron Ishai, Dan Schwarzfuchs

Effective chest compressions have been proven to be a key element in a successful cardiopulmonary resuscitation (CPR). However, unintended injuries have been described in the medical literature for decades, including major intrathoracic injuries. We present a case of an 80-year-old man after a successful CPR who was later diagnosed with deep epicardial laceration as a result of effective chest compressions.

有效的胸部按压已被证明是成功的心肺复苏(CPR)的关键因素。然而,在医学文献中,意外伤害已经被描述了几十年,包括严重的胸内损伤。我们提出一个病例80岁的男子成功心肺复苏术后,谁后来被诊断为深心外膜撕裂,由于有效的胸部按压。
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引用次数: 0
Letter to the Editor Regarding First Admission Neutrophil-Lymphocyte Ratio and Ischemic Stroke. 致编辑关于首次入院中性粒细胞-淋巴细胞比率与缺血性中风的信。
IF 1.5 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2021-10-25 DOI: 10.5041/RMMJ.10456
Rujittika Mungmunpuntipantip, Viroj Wiwanitkit
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引用次数: 0
Human Papilloma Virus and Cancer Stem Cell markers in Oral Epithelial Dysplasia-An Immunohistochemical Study. 人乳头瘤病毒和肿瘤干细胞标记物在口腔上皮发育不良中的免疫组织化学研究
IF 1.5 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2021-10-25 DOI: 10.5041/RMMJ.10451
Prasanth Thankappan, Madhavan Nirmal Ramadoss, Tharmasahayam Isaac Joseph, Percy Ida Augustine, Isaacjoseph Bevin Shaga, Jashree Thilak

Objectives: To study the correlation between the putative cancer stem cell (CSC) markers aldehyde dehydrogenase 1 (ALDH1), cluster of differentiation 44 (CD44), sex-determining region Y-box 2 (SOX2), and octamer-binding protein 4 (OCT4) and human papilloma virus (HPV) infection using p16, the surrogate marker of HPV in oral epithelial dysplasia (OED) and normal mucosa.

Methods: Five sections each from 40 histopathologically diagnosed cases of different grades of OED and 10 cases of normal oral mucosa without dysplasia were immunohistochemically stained with p16, ALDH1, CD44, SOX2, and OCT4, respectively.

Results: Expression of ALDH1 and SOX2 was significantly increased in OED cases, whereas CD44 and OCT4 expression was increased in normal mucosa. P16-positive OED cases showed upregulation of ALDH1 and OCT4 expression as compared to p16-negative cases, while CD44 and SOX2 expression was downregulated in p16-positive OED cases; however, the results were not statistically significant.

Conclusion: The present study indicated a suggestive link between p16 and cancer stem cell marker expression in HPV-associated OED, and that p16 has a significant role in CSC progression in OED. This is the first study to evaluate the expression of putative CSC markers in HPV-associated OED. However, low study numbers are a potential limiting factor in this study.

目的:利用口腔上皮发育不良(OED)和正常粘膜中HPV的替代标志物p16,研究推定的肿瘤干细胞(CSC)标志物乙醛脱氢酶1 (ALDH1)、分化簇44 (CD44)、性别决定区Y-box 2 (SOX2)和八聚体结合蛋白4 (OCT4)与人乳头瘤病毒(HPV)感染的相关性。方法:对40例经组织病理学诊断的不同程度的口腔粘膜病变和10例未发生异常增生的正常口腔黏膜各5张切片分别进行p16、ALDH1、CD44、SOX2、OCT4免疫组化染色。结果:在OED中ALDH1和SOX2的表达明显升高,而CD44和OCT4在正常粘膜中表达升高。与p16阴性患者相比,p16阳性患者ALDH1和OCT4表达上调,而p16阳性患者CD44和SOX2表达下调;然而,结果没有统计学意义。结论:本研究提示p16与hpv相关的OED中癌症干细胞标记物表达之间存在关联,并且p16在OED中CSC的进展中起重要作用。这是第一个评估hpv相关OED中推测的CSC标记表达的研究。然而,研究人数少是本研究的一个潜在限制因素。
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引用次数: 1
Medieval Roots of the Myth of Jewish Male Menstruation. 犹太男性月经神话的中世纪根源。
IF 1.5 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2021-10-25 DOI: 10.5041/RMMJ.10454
Noga Roguin Maor, Ariel Roguin, Nathan Roguin

The Jews in Western Europe during the middle ages were often perceived as distinct from other people not only in their religion, but also by virtue of peculiar physical characteristics. Male Jews were circumcised, which made them physically distinct in the sexual realm. They were believed to have a flux of blood due to hemorrhoids that was thought to more abound in Jews because they consumed salty foods and gross undigested blood, and were melancholic. By the late medieval and early modern periods, the male menstruation motif had become closely connected to the theory of the four humors and the balance between bodily fluids. Men in general were thought of as emitting extra heat, whereas women were considered to be physically cooler. While most men were generally able to reduce their heat naturally, there was a perception that womanish Jewish males were unable to do so, and thereby required "menstruation" (i.e. a literal discharge of blood) in order to achieve bodily equilibrium. The Jewish male image as having menses due to bleeding hemorrhoids was an anti-Semitic claim that had a religious explanation: Jews menstruated because they had been beaten in their hindquarters for having crucified Jesus Christ. This reflection is one of the first biological-racial motifs that were used by the Christians. Preceding this, anti-Semitic rationalizations were mostly religious. However, once these Christians mixed anti-Semitism with science, by emphasizing the metaphorical moral impurity of Jews, the subsequent belief that Jewish men "menstruated" developed-a belief that would have dire historical consequences for the Jewish communities of Europe until even the mid-twentieth century. This topic has direct applicability to current medical practice. The anti-Semitic perspective of Jewish male menstruation would never have taken hold if the medical community had not ignored the facts, and if the population in general had had a knowledge of the facts. In the same way, it is important for present-day scientists and healthcare professionals to understand thoroughly a topic and not to deliberately ignore the facts, which can affect professional and public thought, thereby leading to incorrect and at times immoral conclusions.

中世纪西欧的犹太人不仅在宗教信仰上,而且在身体特征上也常常被认为与其他人不同。男性犹太人受割礼,这使他们在性领域的生理上与众不同。他们被认为是由于痔疮而出血,而痔疮在犹太人中被认为更多,因为他们吃咸的食物和未消化的血液,而且很忧郁。到了中世纪晚期和现代早期,男性月经的主题已经与四种体液和体液平衡的理论紧密联系在一起。一般来说,男性被认为散发出更多的热量,而女性则被认为身体更冷。虽然大多数男性通常能够自然地降低体温,但有一种看法认为,女性化的犹太男性无法做到这一点,因此需要“月经”(即字面上的放血)来达到身体的平衡。犹太男性因痔疮出血而来月经的形象是一种反犹太主义的说法,有宗教上的解释:犹太人来月经是因为他们因钉死耶稣基督而被鞭打。这种反映是基督教徒最早使用的生物种族主题之一。在此之前,反犹太主义的合理化主要是宗教上的。然而,一旦这些基督徒将反犹太主义与科学结合起来,通过强调犹太人道德上的不洁,随后犹太人“月经”的信仰就发展起来了——这种信仰对欧洲的犹太社区产生了可怕的历史后果,直到20世纪中叶。这个话题对当前的医学实践有直接的适用性。如果医学界没有忽视这些事实,如果普通民众了解这些事实,犹太男性月经的反犹太观点就永远不会站稳脚跟。同样,对于当今的科学家和医疗保健专业人员来说,彻底理解一个主题,而不是故意忽视事实,这一点很重要,因为事实会影响专业和公众的思想,从而导致不正确的,有时甚至是不道德的结论。
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引用次数: 0
Is the Rotavirus Vaccine Really Associated with a Decreased Risk of Developing Celiac and Other Autoimmune Diseases? 轮状病毒疫苗真的能降低患乳糜泻和其他自身免疫性疾病的风险吗?
IF 1.5 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2021-10-25 DOI: 10.5041/RMMJ.10450
Ibrahim Kiliccalan

This review examines the risk of developing celiac disease (CD) and other autoimmune diseases in individuals receiving the rotavirus (RV) vaccine compared to the normal population. Celiac disease is a malabsorptive, chronic, immune-mediated enteropathy involving the small intestine. The pathogenesis of CD is multifactorial, and mucosal immunity plays an important role in its development. Low mucosal IgA levels significantly increase the risk of developing the disease. Rotavirus is an infectious agent that causes diarrhea, particularly in children aged 0-24 months, and is frequently involved in diarrhea-related deaths in these children. An oral vaccine against RV has been developed. While it is effective on RV infection, it also contributes to increasing mucosal immunity. Studies have indicated that individuals immunized with the RV vaccine are at lower risk of developing CD than unvaccinated individuals. In addition, the mean age for developing CD autoimmunity may be higher in the vaccinated group than in controls receiving placebo. Additional studies that include children immunized with different RV vaccines and unvaccinated children would provide more meaningful results. Although current data suggest a possible association of RV vaccination with a reduced risk of developing CD and other autoimmune diseases, this remains an unanswered question that merits greater international investigation.

本综述探讨了与正常人群相比,接种轮状病毒(RV)疫苗的个体发生乳糜泻(CD)和其他自身免疫性疾病的风险。乳糜泻是一种吸收不良的慢性免疫介导的肠病,累及小肠。乳糜泻的发病机制是多因素的,粘膜免疫在其发病过程中起重要作用。低黏膜IgA水平显著增加患病风险。轮状病毒是一种引起腹泻的传染因子,特别是在0-24个月的儿童中,并且经常涉及这些儿童与腹泻相关的死亡。已经研制出一种抗RV的口服疫苗。在对RV感染有效的同时,它也有助于提高黏膜免疫力。研究表明,接种RV疫苗的个体患乳糜泻的风险低于未接种疫苗的个体。此外,接种疫苗组发生乳糜泻自身免疫的平均年龄可能高于接受安慰剂的对照组。对接种了不同RV疫苗的儿童和未接种疫苗的儿童进行的进一步研究将提供更有意义的结果。尽管目前的数据表明,RV疫苗接种可能与降低乳糜泻和其他自身免疫性疾病的风险有关,但这仍然是一个悬而未决的问题,需要进行更多的国际调查。
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引用次数: 1
期刊
Rambam Maimonides Medical Journal
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