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Surgical Correction of Non-traumatic Patella Maltracking. Midterm Clinical Follow-up 非外伤性髌骨畸形的手术矫正。中期临床随访
IF 1.5 Q2 Medicine Pub Date : 2022-03-13 DOI: 10.5041/RMMJ.10465
Eran Keltz, D. Ofir, Y. Beer, Naama Gruber, Mezen Falah, G. Nierenberg
Background Patellar instability comprises a group of pathologies that allow the patella to move out of its trajectory within the trochlear groove during walking. Symptomatic patients who need surgery commonly undergo soft tissue procedures such as medial patellofemoral ligament repair to strengthen the ligaments that hold the patella in place. However, soft-tissue repairs may be insufficient in patients suffering from patellar maltracking, which is characterized by an unbalanced gliding of the patella within its route. In these patients, a different approach is advised. We aim to provide the mid-term clinical outcomes of the Fulkerson distal realignment operation in selected patients with non-traumatic patellar maltracking. Methods The clinical outcomes of the Fulkerson distal realignment operation performed in 22 knees of 21 patients were evaluated by a self-administered subjective International Knee Documentation Committee (IKDC) score and the Tegner–Lysholm knee scoring scale. Results Before surgery, the median IKDC score was 52, and the median Tegner–Lysholm score was 56. Following surgery (mean follow-up 48 months, range 24–156), the median IKDC and the Tegner–Lysholm scores were 67 and 88, respectively. The improvement was statistically significant (P=0.001 and P=0.002 for IKDC and Tegner–Lysholm scores, respectively). Associated procedures included patella microfracture due to grade III–IV cartilage lesion (International Cartilage Repair Society grading system) in four patients, retinacular releases in three patients, medial capsular augmentations in two patients, and medial patellofemoral ligament reconstruction in two patients. One patient with Ehlers–Danlos disease required excessive medialization of the tibial tuberosity. Surgery-related complications occurred in three patients. Discussion Surgical correction of patellar maltracking with Fulkerson distal realignment combined with associated procedures in individual patients was associated with an increase in subjective and functional clinical scores at medium-term follow-up. Particular attention should address pathologies associated with patellar maltracking and managed accordingly. Level of evidence 4c (case series).
髌骨不稳定包括一组病理,这些病理允许髌骨在行走时在滑车沟内移动出其轨迹。需要手术的有症状的患者通常会进行软组织手术,如内侧髌股韧带修复,以加强将髌骨固定在适当位置的韧带。然而,对于髌骨追踪不良的患者,软组织修复可能是不够的,其特征是髌骨在其路径内滑动不平衡。对于这些患者,建议采用不同的方法。我们的目的是提供中期临床结果的Fulkerson远端复位手术的患者的非创伤性髌骨畸形。方法采用国际膝关节文献委员会(International Knee Documentation Committee, IKDC)评分和Tegner-Lysholm膝关节评分量表对21例患者22个膝关节进行Fulkerson远端复位手术的临床疗效进行评估。结果术前IKDC评分中位数为52分,Tegner-Lysholm评分中位数为56分。手术后(平均随访48个月,范围24-156),中位IKDC和Tegner-Lysholm评分分别为67和88。改善具有统计学意义(IKDC和Tegner-Lysholm评分分别为P=0.001和P=0.002)。相关手术包括4例因III-IV级软骨损伤(国际软骨修复协会分级系统)导致的髌骨微骨折,3例支持带松解,2例内侧囊增强,2例内侧髌股韧带重建。1例ehers - danlos病患者需要胫骨结节过度内侧化。3例患者出现手术相关并发症。在中期随访中,采用Fulkerson远端复位联合相关手术对个别患者进行髌骨畸形矫正与主观和功能临床评分的增加有关。应特别注意与髌骨错位相关的病理,并进行相应的管理。证据等级4c(案例系列)。
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引用次数: 0
COVID-19 and Preeclampsia: Overlapping Features in Pregnancy. COVID-19和子痫前期:妊娠的重叠特征
IF 1.5 Q2 Medicine Pub Date : 2022-01-27 DOI: 10.5041/RMMJ.10464
Ramasamy Sathiya, Jayanthi Rajendran, Saravanan Sumathi

Coronavirus disease 2019 (COVID-19) is a global respiratory disease with unique features that have placed all medical professionals in an alarming situation. Preeclampsia is a hypertensive disorder of pregnancy affecting 8%-10% of India's pregnant population. Assuming that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) enters host cells through the angiotensin-converting enzyme 2 (ACE2) receptor, the resulting symptoms are due to vasoconstriction, caused by disturbances in the renin-angiotensin system (RAS). Other features of preeclampsia include endothelial dysfunction due to placental ischemia, leading to imbalances in angiogenic and antiangiogenic factors which result in increased blood pressure, proteinuria, altered hepatic enzymes, renal failure, and thrombocytopenia, amongst others. The increased prevalence of preeclampsia that was seen among mothers with SARS-CoV-2 infection might be due to misdiagnosis, as COVID-19 and preeclampsia have coincidental medical features. The major similarities of SARS-CoV-2-infected and preeclamptic women are a rise in pro-inflammatory cytokines, and increased serum ferritin and thrombocytopenia. Therefore, differential diagnosis might be difficult in pregnant women with COVID-19 who present with hypertension and proteinuria, thrombocytopenia, or elevated liver enzymes. The most promising markers for earlier diagnosis of preeclampsia is soluble endoglin (sEng), pregnancy-associated plasma protein-A (PAPP-A), soluble fms-like tyrosine kinase 1 (sFlt-1), and placental growth factor (PlGF). Due to placental hypoxia, sFlt-1 will be overproduced, thus inhibiting PlGF, and this alteration will be observed in the circulation five weeks or more before the onset of symptoms. The sFlt-1/PlGF ratio may also be modified via infectious states, but unregulated levels of those mediators are related to placental insufficiency. Hence, pregnant women with COVID-19 may develop a preeclampsia-like syndrome that might be differentiated properly by angiogenic markers to avoid unnecessary interventions and induced preterm labor.

2019冠状病毒病(COVID-19)是一种具有独特特征的全球性呼吸系统疾病,使所有医疗专业人员处于令人担忧的境地。子痫前期是一种妊娠期高血压疾病,影响了印度8%-10%的孕妇。假设严重急性呼吸综合征冠状病毒2 (SARS-CoV-2)通过血管紧张素转换酶2 (ACE2)受体进入宿主细胞,由此产生的症状是由于肾素-血管紧张素系统(RAS)紊乱引起的血管收缩。子痫前期的其他特征包括胎盘缺血引起的内皮功能障碍,导致血管生成和抗血管生成因子失衡,从而导致血压升高、蛋白尿、肝酶改变、肾功能衰竭和血小板减少等。在感染SARS-CoV-2的母亲中发现的先兆子痫患病率增加可能是由于误诊,因为COVID-19和先兆子痫具有巧合的医学特征。sars - cov -2感染和子痫前期妇女的主要相似之处是促炎细胞因子升高,血清铁蛋白和血小板减少症升高。因此,对于伴有高血压、蛋白尿、血小板减少或肝酶升高的COVID-19孕妇,鉴别诊断可能很困难。早期诊断子痫前期最有希望的标志物是可溶性内啡肽(sEng)、妊娠相关血浆蛋白-a (PAPP-A)、可溶性膜样酪氨酸激酶1 (sFlt-1)和胎盘生长因子(PlGF)。由于胎盘缺氧,sFlt-1会过量产生,从而抑制PlGF,这种改变会在症状出现前5周或更长时间在循环中观察到。sFlt-1/PlGF比值也可能通过感染状态而改变,但这些介质的不调节水平与胎盘功能不全有关。因此,感染COVID-19的孕妇可能会出现子痫前期样综合征,可通过血管生成标志物适当区分,以避免不必要的干预和诱发早产。
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引用次数: 18
Impact of an Integrated Yoga Therapy Protocol on Insulin Resistance and Glycemic Control in Patients with Type 2 Diabetes Mellitus. 综合瑜伽治疗方案对2型糖尿病患者胰岛素抵抗和血糖控制的影响
IF 1.5 Q2 Medicine Pub Date : 2022-01-27 DOI: 10.5041/RMMJ.10462
Manoharan Mangala Gowri, Jayanthi Rajendran, Abu Raghavan Srinivasan, Ananda Balayogi Bhavanani, Ramanathan Meena

Objective: Diabetes mellitus (DM), characterized by chronic hyperglycemia, is attributed to relative insulin deficiency or resistance, or both. Studies have shown that yoga can modulate parameters of insulin resistance. The present study explored the possible beneficial effects of integrated yoga therapy with reference to glycemic control and insulin resistance (IR) in individuals with diabetes maintained on standard oral medical care with yoga therapy, compared to those on standard oral medical care alone.

Methods: In this study, the subjects on yoga intervention comprised 35 type 2 diabetics, and an equal number of volunteers constituted the control group. Subjects ranged in age from 30 to 70 years, with hemoglobin A1c (HbA1c) test more than 7%, and were maintained on diabetic diet and oral hypoglycemic agents. Blood samples were drawn prior to and after 120 days of integrated yoga therapy intervention. Fasting blood glucose (FBG), post-prandial blood glucose (PPBG), HbA1c, insulin, and lipid profile were assessed in both the intervention and control groups.

Results: The intervention group revealed significant improvements in body mass index (BMI) (0.7 kg/m2 median decrease; P=0.001), FBG (20 mg/dL median decrease; P<0.001), PPBG (33 mg/dL median decrease; P<0.001), HbA1c (0.4% median decrease; P<0.001), homeostatic model assessment for insulin resistance (HOMA-IR) (1.2 median decrease; P<0.001), cholesterol (13 mg/dL median decrease, P=0.006), triacylglycerol (22 mg/dL median decrease; P=0.027), low-density lipoprotein (6 mg/dL median decrease; P=0.004), and very-low-density lipoprotein levels (4 mg/dL median decrease; P=0.032). Increases in high-density lipoprotein after 120 days were not significant (6 mg/dL median increase; P=0.15). However, when compared to changes observed in patients in the control group, all these improvements proved to be significant.

Conclusion: Administration of integrated yoga therapy to individuals with diabetes leads to a significant improvement in glycemic control, insulin resistance, and key biochemical parameters.

目的:以慢性高血糖为特征的糖尿病(DM)是由于相对胰岛素缺乏或抵抗,或两者兼而有之。研究表明,瑜伽可以调节胰岛素抵抗的参数。本研究探讨了综合瑜伽疗法对糖尿病患者的血糖控制和胰岛素抵抗(IR)的可能有益影响,与单独进行标准口腔医疗护理的患者相比,瑜伽疗法对糖尿病患者的血糖控制和胰岛素抵抗(IR)的影响。方法:本研究以35名2型糖尿病患者为瑜伽干预对象,并以同样数量的志愿者为对照组。受试者年龄30 ~ 70岁,糖化血红蛋白(HbA1c)≥7%,维持糖尿病饮食及口服降糖药。在综合瑜伽疗法干预前后120天抽取血液样本。评估干预组和对照组的空腹血糖(FBG)、餐后血糖(PPBG)、糖化血红蛋白(HbA1c)、胰岛素和血脂。结果:干预组体重指数(BMI)显著改善(中位数下降0.7 kg/m2;P=0.001),空腹血糖(中位数下降20 mg/dL;结论:对糖尿病患者进行综合瑜伽治疗可显著改善血糖控制、胰岛素抵抗和关键生化指标。
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引用次数: 3
Nailfold Videocapillaroscopy in Connective Tissue Diseases with Raynaud's Phenomenon in an Indian Population. 甲襞视频毛细血管镜检查在印度人群中结缔组织疾病与雷诺现象。
IF 1.5 Q2 Medicine Pub Date : 2022-01-27 DOI: 10.5041/RMMJ.10460
Sambit Sundaray, Siddhartha Mishra, Subhash Chandra Dash, Naba Kishore Sundaray

Introduction: Microvasculopathy is characterized by progressive structural and functional damage to the microvessels and plays a key role in the pathogenesis of various connective tissue diseases (CTD). Nailfold videocapillaroscopy is an optimal and validated method for analysis of microvascular abnormalities and is able to differentiate secondary Raynaud's phenomenon (RP) of CTD from primary RP and healthy subjects.

Aim: To assess and analyze nailfold capillaroscopic findings in Indian subjects with secondary Raynaud and to compare with findings in healthy subjects.

Methods: A total of 62 study participants including cases and controls underwent nailfold videocapillaroscopy. Capillary loop length, capillary width, capillary density, presence/absence of tortuosity, giant loops, neoangiogenesis, microhemorrhages, and avascular areas were the parameters studied.

Results: All the quantitative and qualitative parameters studied were significantly associated with secondary RP. Mean loop length in cases of connective tissue diseases was significantly less than in the controls (225.74 μm versus 282.97 μm) (P=0.002). Capillary density was also reduced significantly in the cases as compared to the controls (4.6 versus 7.39/mm) (P<0.01), whereas it was markedly decreased in systemic sclerosis (SSc) and mixed connective tissue diseases (MCTD), and near normal in systemic lupus erythematosus (SLE). Tortuosity was the most frequent (77.4%) qualitative parameter. Scleroderma pattern was found in 62.5% of patients with SSc and in 60% with MCTD. Non-specific pattern was found in 80% of SLE cases and 50% of dermatomyositis cases.

Conclusion: Both quantitative and qualitative capillaroscopic changes are significantly associated with secondary RP. Scleroderma pattern was predominant in SSc and MCTD, whereas non-specific pattern was predominantly found in SLE and dermatomyositis.

微血管病变以微血管的进行性结构和功能损伤为特征,在各种结缔组织疾病(CTD)的发病机制中起着关键作用。甲襞视频毛细血管镜检查是一种分析微血管异常的最佳和有效的方法,能够区分CTD继发性雷诺现象(RP)与原发性RP和健康受试者。目的:评价和分析印度继发性雷诺患者的甲襞毛细血管镜检查结果,并与健康人的结果进行比较。方法:共有62名研究参与者,包括病例和对照组,接受甲襞视频毛细血管镜检查。毛细血管袢长度、毛细血管宽度、毛细血管密度、是否存在扭曲、巨袢、新生血管生成、微出血和无血管区是研究的参数。结果:所研究的所有定量和定性参数均与二次RP有显著相关。结缔组织疾病患者的平均环路长度明显小于对照组(225.74 μm vs 282.97 μm) (P=0.002)。与对照组相比,这些病例的毛细血管密度也显著降低(4.6对7.39/mm)(结论:定量和定性毛细血管镜改变与继发性RP显著相关。硬皮病型主要见于SSc和MCTD,而非特异性型主要见于SLE和皮肌炎。
{"title":"Nailfold Videocapillaroscopy in Connective Tissue Diseases with Raynaud's Phenomenon in an Indian Population.","authors":"Sambit Sundaray,&nbsp;Siddhartha Mishra,&nbsp;Subhash Chandra Dash,&nbsp;Naba Kishore Sundaray","doi":"10.5041/RMMJ.10460","DOIUrl":"https://doi.org/10.5041/RMMJ.10460","url":null,"abstract":"<p><strong>Introduction: </strong>Microvasculopathy is characterized by progressive structural and functional damage to the microvessels and plays a key role in the pathogenesis of various connective tissue diseases (CTD). Nailfold videocapillaroscopy is an optimal and validated method for analysis of microvascular abnormalities and is able to differentiate secondary Raynaud's phenomenon (RP) of CTD from primary RP and healthy subjects.</p><p><strong>Aim: </strong>To assess and analyze nailfold capillaroscopic findings in Indian subjects with secondary Raynaud and to compare with findings in healthy subjects.</p><p><strong>Methods: </strong>A total of 62 study participants including cases and controls underwent nailfold videocapillaroscopy. Capillary loop length, capillary width, capillary density, presence/absence of tortuosity, giant loops, neoangiogenesis, microhemorrhages, and avascular areas were the parameters studied.</p><p><strong>Results: </strong>All the quantitative and qualitative parameters studied were significantly associated with secondary RP. Mean loop length in cases of connective tissue diseases was significantly less than in the controls (225.74 μm versus 282.97 μm) (P=0.002). Capillary density was also reduced significantly in the cases as compared to the controls (4.6 versus 7.39/mm) (P<0.01), whereas it was markedly decreased in systemic sclerosis (SSc) and mixed connective tissue diseases (MCTD), and near normal in systemic lupus erythematosus (SLE). Tortuosity was the most frequent (77.4%) qualitative parameter. Scleroderma pattern was found in 62.5% of patients with SSc and in 60% with MCTD. Non-specific pattern was found in 80% of SLE cases and 50% of dermatomyositis cases.</p><p><strong>Conclusion: </strong>Both quantitative and qualitative capillaroscopic changes are significantly associated with secondary RP. Scleroderma pattern was predominant in SSc and MCTD, whereas non-specific pattern was predominantly found in SLE and dermatomyositis.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8798589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39964490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Can Endoscopic Appearance, Selective Cytology, and Pathological Sampling During Ureteroscopy Accurately Predict Tumor Grade of Upper-Tract Urothelial Carcinoma? 输尿管镜检查时的内镜表现、选择性细胞学和病理取样能否准确预测上尿路上皮癌的肿瘤分级?
IF 1.5 Q2 Medicine Pub Date : 2022-01-27 DOI: 10.5041/RMMJ.10459
Kamil Malshy, Omri Nativ, Ariel Zisman, Omer Sadeh, Azik Hoffman, Gilad E Amiel, Michael Mullerad

Objective: This study examined the reliability of the various parameters obtained in diagnostic ureteroscopy for upper-tract urothelial carcinoma (UTUC) in predicting the degree of differentiation in the final pathological report after radical nephroureterectomy (RNU).

Methods: We conducted a retrospective review of patients undergoing RNU at a single tertiary hospital between 2000 and 2020. Only patients who underwent preoperative diagnostic ureteroscopy (URS) were included. The results of urine selective cytology, endoscopic appearance of the tumor, and biopsy taken during ureteroscopy were compared to the final pathological report.

Results: In total, 111 patients underwent RNU. A preliminary URS was performed in 54. According to endoscopic appearance, 40% of the "solid"-looking tumors were high grade (HG), while 52% of those with a papillary appearance were low grade (LG). Positive cytology predicted HG tumors in 86% of cases. However, 42% of patients with negative cytology had HG disease. The biopsies acquired during URS showed that HG disease findings matched the final pathology in 75% of cases. However, 25% of patients noted as being HG, based on URS biopsies, were noted to have LG disease based on nephroureterectomy biopsies. Full analyses revealed that 40% of the cases diagnosed as LG based on the URS biopsies actually had HG disease.

Conclusions: Direct tumor observation of papillary lesions, negative cytology, and biopsies indicating LG disease are of low predictive value for classifying the actual degree of tumor differentiation. No single test can accurately rule out HG disease. In light of the rising use of neo-adjuvant chemotherapy in UTUC, a reliable predictive model should be developed that accurately discriminates between HG and LG disease.

目的:本研究探讨上路尿路上皮癌(UTUC)诊断输尿管镜检查中获得的各项参数预测根治性肾输尿管切除术(RNU)后最终病理报告中分化程度的可靠性。方法:我们对2000年至2020年在一家三级医院接受RNU的患者进行了回顾性分析。仅包括术前诊断性输尿管镜检查(URS)的患者。将尿液选择性细胞学检查结果、内镜下肿瘤表现和输尿管镜下活检结果与最终病理报告进行比较。结果:111例患者行RNU手术。54年进行初步尿路重建。根据内镜外观,40%的“实体”外观肿瘤为高级别(HG),而52%的乳头状外观肿瘤为低级别(LG)。86%的病例细胞学阳性预测HG肿瘤。然而,42%的细胞学阴性患者患有HG疾病。尿潴留期间获得的活检显示,75%的病例的HG疾病结果与最终病理相符。然而,25%根据尿路穿刺活检诊断为HG的患者,根据肾输尿管切除术活检诊断为LG疾病。充分的分析显示,40%的病例诊断为LG根据尿路活检实际上有HG疾病。结论:直接观察肿瘤乳头状病变,细胞学阴性,活检提示LG病,对判别肿瘤实际分化程度的预测价值较低。没有单一的检查可以准确地排除HG疾病。鉴于UTUC中新辅助化疗的使用越来越多,应该开发一种可靠的预测模型来准确区分HG和LG疾病。
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引用次数: 0
An Approach to Nasopharyngeal Mass in Newborns: Case Series and Systematic Literature Review. 新生儿鼻咽部肿块的诊断:病例系列和系统文献综述。
IF 1.5 Q2 Medicine Pub Date : 2022-01-27 DOI: 10.5041/RMMJ.10463
Roee Noy, Liron Borenstein-Levin, Arie Gordin

Objective: Congenital nasopharyngeal masses (CNMs) are rare. Presenting symptoms vary, and the differential diagnoses cover a wide spectrum of possibilities. As it is uncommon, most examples discussed in literature are described as case reports or series. Guidelines on CNM patient management do not exist. In this study, we present two (2) cases of neonates with CNMs that were encountered at our tertiary center. Additionally, to best elaborate a comprehensive, case-based approach to CNM management, we offer an up-to-date, diagnosis-to-treatment review of current literature.

Methods: Case series and systematic literature review.

Results: Twenty-eight (28) studies are included since January 2000 to October 2021, with a total of 41 cases. Most common diagnosis was teratoma (78%). Female-to-male ratio was 2.5:1. Twenty percent of cases presented prenatally with polyhydramnios or elevated alpha-fetoprotein. Postnatally, the presenting symptoms most frequently encountered were respiratory distress (78%), oral mass (52%), and feeding difficulties (29%). Seventy-five percent of affected newborns showed symptoms within the first 24 hours of life. Forty percent of cases had comorbidities, especially in the head and neck region.

Conclusions: Congenital nasopharyngeal masses can be detected antenatally, or symptomatically immediately after birth. Airway protection is a cornerstone in the management. Selecting the right imaging modality and convening a multidisciplinary team meeting are important toward the planning of next steps/therapeutic approach. Typically, a transnasal or transoral surgical approach will be deemed sufficient to address the problem, with a good overall prognosis.

目的:先天性鼻咽部肿块(CNMs)是罕见的。表现出的症状各不相同,鉴别诊断涵盖了广泛的可能性。由于不常见,文献中讨论的大多数例子都以病例报告或系列描述。CNM患者管理指南尚不存在。在这项研究中,我们提出了在我们的三级中心遇到的两(2)例新生儿CNMs。此外,为了最好地阐述一个全面的、基于病例的CNM管理方法,我们提供了一个最新的、从诊断到治疗的文献综述。方法:采用病例法和系统文献法。结果:2000年1月至2021年10月共纳入28项研究,共41例。最常见的诊断是畸胎瘤(78%)。男女比例为2.5:1。20%的病例在产前表现为羊水过多或甲胎蛋白升高。出生后,最常见的症状是呼吸窘迫(78%)、口腔团块(52%)和喂养困难(29%)。75%的受感染新生儿在出生后24小时内出现症状。40%的病例有合并症,尤其是头颈部。结论:先天性鼻咽肿块可在产前发现,或在出生后立即出现症状。气道保护是管理的基石。选择正确的成像方式和召开多学科小组会议对于规划下一步/治疗方法非常重要。通常,经鼻或经口手术方法被认为足以解决问题,总体预后良好。
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引用次数: 0
The Changing Epidemiology of Carbapenemase-Producing Enterobacterales. 产碳青霉烯酶肠杆菌的流行病学变化。
IF 1.5 Q2 Medicine Pub Date : 2022-01-27 DOI: 10.5041/RMMJ.10461
Khetam Hussein, Yuval Geffen, Orna Eluk, Sigal Warman, Worood Aboalheja, Tamar Alon, Ibrahim Firan, Mical Paul

Objective: Israeli hospitals were confronted with a major national outbreak of carbapenemase-producing Enterobacterales (CPE) starting in 2006, caused predominantly by monoclonal Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae. Our hospital, Rambam Health Care Campus (RHCC), was one of the medical centers affected by this outbreak. We aimed to investigate the changing epidemiology of CPE at RHCC since 2006.

Methods: This was a retrospective observational cohort study performed in Northern Israel (Haifa) at RHCC, which is a primary tertiary acute care academic hospital. The study included all patients who had acquired CPE at RHCC between January 2005 and December 2020.

Results: The proportion of patients infected with K. pneumoniae dropped from 100% of all CPE in the first years to 28% (37/134) in 2020. In 2014, the carbapenemase in 94% of all CPE patients (89/95) was KPC. This decreased to 56% in 2020, while New Delhi metallo-β-lactamase (NDM) and OXA-48 carbapenemases increased from 4% and 2% to 29% (39/134) and 12.7% (17/134) of CPE, respectively.

Conclusions: The CPE epidemic evolved from KPC-producing K. pneumoniae to involve different Enterobacterales and carbapenemases. Our results are a microcosm of the current global epidemiology attesting to globalization in bacteriology. The results have implications for infection control and antibiotic treatment of CPE infections.

目的:2006年起,以色列医院爆发了一场全国性产碳青霉烯酶肠杆菌(CPE)暴发,主要由产碳青霉烯酶肺炎克雷伯菌(KPC)引起。我们的医院,兰巴姆卫生保健校区(RHCC),是受此次疫情影响的医疗中心之一。我们的目的是调查自2006年以来RHCC CPE的流行病学变化。方法:这是一项在以色列北部(海法)RHCC进行的回顾性观察队列研究,RHCC是一家初级三级急性护理学术医院。该研究包括2005年1月至2020年12月期间在RHCC获得CPE的所有患者。结果:肺炎克雷伯菌感染的患者比例从第一年的100%下降到2020年的28%(37/134)。2014年,94%的CPE患者(89/95)的碳青霉烯酶为KPC。到2020年,这一比例降至56%,而新德里金属β-内酰胺酶(NDM)和OXA-48碳青霉烯酶在CPE中的比例分别从4%和2%上升至29%(39/134)和12.7%(17/134)。结论:CPE流行由产kpc肺炎克雷伯菌演变而来,涉及不同肠杆菌和碳青霉烯酶。我们的结果是当前全球流行病学的一个缩影,证明了细菌学的全球化。该结果对CPE感染的感染控制和抗生素治疗具有指导意义。
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引用次数: 2
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 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 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 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
期刊
Rambam Maimonides Medical Journal
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