Background and Aims: Irritable bowel syndrome (IBS) poses a significant healthcare challenge, characterized by chronic gastrointestinal and extraintestinal symptoms impacting individuals’ well-being. Treatment preferences may vary among patients from different ethnic groups, such as Arab and Jewish Israelis, necessitating tailored approaches.
Methods: A bilingual (Hebrew/Arabic) questionnaire assessing patients’ preferences regarding treatment goals was developed. It was administered online in Israeli IBS Facebook groups, as well as in two hospital gastroenterology clinics.
Results: The study included 267 IBS patients (91 Arabs and 176 Jews). Demographic analysis revealed a higher proportion of females in both groups, with a significantly greater percentage among Jews compared to Arabs (84% versus 64.8%, respectively, P<0.001). The median age was 32 years for both Arabs and Jews (interquartile ranges of 26–42 and 24–62, respectively). Arabs exhibited higher rates of mixed-type IBS and constipation, while Jews had a higher prevalence of predominant diarrhea IBS. Arabs reported more bloating, higher rates of IBS-related comorbidities, and more medication usage. When asked to rate the importance of treatment goals, both populations preferred improvement in abdominal pain, bloating, and regular defecation, while assigning lower importance to improving difficulty in mental and/or physical aspects of intercourse, as well as arthralgia and myalgia. Arab patients assigned lower importance scores to various symptoms compared to their Jewish counterparts.
Conclusion: This study highlights the impact of ethnicity on patients’ treatment goals. Understanding patients’ preferences will enable tailoring an individual approach to each IBS patient.
Dear Editor, ... The recommendation by Roth and Wald to en-force stricter regalia policies and uphold profession-alism at commencements is crucial. However, such measures should be complemented by proactive educational interventions. ...
The recently published paper “US Medical Schools’ 2024 Commencements and Antisemitism: Addressing Unprofessional Behavior” discusses antisemitism expressions and unprofessional behavior in US medical schools’ 2024 commencement ceremony. While we share the authors’ concerns regarding rising antisemitic, anti-Palestinian and anti-Muslim bias, alongside hateful behavior toward minorities and immigrants in the US in general and in medical schools in particular, we are also concerned about the significant bias informing this paper. The authors mistakenly conflate antisemitism with harsh criticism of Israeli government and the actions of its military, and legitimate acts of solidarity with people under oppression. This fallacy is further aggravated by serious concerns (mentioned by the authors themselves) involving the paper’s methodological and statistical shortcomings. Ultimately, the paper lacks scientific rigor and appears to be ideologically motivated rather than a contribution to objective research. Scholars worldwide, Jews and Israelis amongst them, have demonstrated that these are legitimate protests, and the interpretation of their messaging as antisemitic is just another way to silence Palestinian voices calling for freedom and liberation, and delegitimizing critique on the Israeli government. This paper aims to provide the reader with currently published evidence and scientific controversy regarding this issue, that the discussed paper failed to mention.
To the Editor,
We read with great interest the article titled “Local Flap Reconstructions in Oral Cavity Defects: An Insight from 104 Cases” and commend the authors for their valuable contribution to the field of reconstructive surgery. We believe that individuals diagnosed with oral cancer undergoing flap reconstruction should have physical therapy incorporated into their prehabilitation and postoperative rehabilitation.
To the Editor. We thank authors Babar as well as Abu Fraiha and Leibowitz for their interest in and correspondence about our paper regarding the regalia and symbols worn by medical students and the protests and disruptions at commencement ceremonies.
Extremism, displacement, and ongoing conflict have affected Palestinians and Israelis personally and collectively, endangering their health and lives. A theory circulating in public health publications posits that settler colonial determinants of health (SCDH) are the root cause of health inequities in the region. We argue that this assertion is misleading, ignores key facts, and exacerbates polarization, thus harming health. Public health is an evidence-based, scientific discipline based on hypotheses, research, and analysis. Throughout the scientific process, careful assessments of bias are essential. Knowledge is subsequently translated into policy and action. The SCDH theory rejects this approach as tainted by “colonialism.” We also argue that the SCDH concept, as applied to health disparities in Israel-Palestine, is an ideologically driven theory in search of evidence. Rather than developing testable hypotheses, the promoters of SCDH use selective evidence to support its relevance to health in the region. The theory collapses when examined against relevant facts related to regional history and the health status of Israelis and Palestinians. It invokes one-sided racism as a driver of health inequities in a context-inappropriate manner, and ignores many upstream determinants including actions of the Palestinian leadership, and their role as drivers of health. It denigrates peace-building and collaboration which are key to future health and wellbeing in the region, and which have a proven record in improving health outcomes. We call on public health professionals to distance themselves from unfounded rhetoric that polarizes the communities, and undermines the discipline’s scientific integrity, while contributing nothing to promote health in the region.
Background: Parental caregivers of children with special needs manage their child’s daily tasks, taking on responsibilities such as making health and financial decisions, assisting with routine activities, and ensuring their safety from self-harm. The level of a child’s disability determines the amount of time and effort a caregiver must invest, with higher disability levels meaning greater dependency and thus requiring greater support. While rewarding, caregiving may also be highly demanding. The parental caregiver’s physical and mental health can decline due to stress, potentially leading to anxiety and depression, and may worsen pre-existing conditions. This research aimed to provide insights into the psychological well-being of parental caregivers, shedding light on their challenges and needs for better support and intervention.
Methods: This study examined the psychological health of parental caregivers of special needs children at a special education school in Puducherry, India. Following an orientation program, 66 parental caregivers volunteered and provided informed consent to participate. The mean age of the parents was 38.4 years (±6.6). Demographic details were collected, and psychological parameters were assessed using standardized scales: Zarit Burden Interview–Caregiver Burden Scale (ZBI-CBS), Depression, Anxiety, Stress Scale (DASS-21), Pittsburgh Sleep Quality Index (PSQI), World Health Organization Quality of Life—brief form (WHOQOL-BREF).
Results: The study findings revealed that most parents experienced caregiver burden and poor sleep quality, consistent with previous studies. Specifically, 93.9% of parents had poor sleep, while 84.8% reported caregiver burden. Additionally, 89.4% of the parents experienced depression, 89.4% have anxiety, and 86.4% have stress. Quality of life was low across all domains.
Conclusion: The stress of managing their child’s needs can negatively impact parental caregivers’ physical and psychological health. Providing counseling and promoting healthy lifestyle choices can significantly enhance caregivers’ overall well-being.
Purpose: This study was aimed at identifying biomarkers that could help exclude pulmonary embolism (PE) in patients aged 65 years and older, considering age-related challenges such as atypical clinical presentations and the presence of comorbidities.
Methods: This single-center cohort study retrospectively collected data on 28 potential markers from patients aged 65 years and older who underwent computed tomography scans for PE diagnosis in emergency or internal wards over a 2.5-year period.
Results: The study included 157 patients after exclusions, with 35 diagnosed with PE. Patients with PE exhibited higher D-dimer levels, lower platelet counts, and higher Padua scores. Six markers were selected based on likelihood ratio, each with an area under the curve above 0.7 and P-value below 0.05. Multiplying D-dimer levels with the Padua score (PaDd) improved specificity from 9% to 32% while maintaining 100% sensitivity in identifying PE. Further refinement by incorporating activated partial thromboplastin time (aPTT) into the Padua score multiplied by D-dimer (PaDd/aPTT) resulted in improved sensitivity and specificity.
Conclusion: The Padua score multiplied by D-dimer is a simple yet effective tool that enhances specificity while maintaining high sensitivity, potentially reducing computed tomography utilization in elderly patients. Prospective, multicenter studies are needed to validate these findings and integrate them into routine clinical practice.
Background: An odontogenic keratocyst is presently considered a cyst by the 2017 World Health Organization (WHO) classification, even though, at times, it shows highly aggressive behavior and a high recurrence rate. Ki-67 is a protein associated with the proliferative activity of the intrinsic cell populations. In tumors, Ki-67 is associated with tumor aggressiveness. This study aimed to compare the Ki-67 expression rates of odontogenic keratocysts to those of other odontogenic cysts and normal mucosa.
Materials and Methods: A retrospective cross-sectional study was conducted using pathology samples retrieved from the archives of a tertiary care center to evaluate Ki-67 expression. Histopathologically confirmed cases of odontogenic keratocysts, radicular cysts, dentigerous cysts, and ameloblastomas were selected. The standardized immunohistochemistry streptavidin–biotin detection system HRP-DAB method was employed for analysis.
Results: All the odontogenic keratocysts pathology samples demonstrated some degree of Ki-67 expres¬sion: mild, moderate, and severe Ki-67 expressions were identified in 26.7%, 53.3%, and 20.0% of the samples, respectively. Compared to the odontogenic keratocyst samples, the samples from dentigerous cysts, periapical cysts, ameloblastomas, and normal mucosa demonstrated no Ki-67 expression in 33.3%–66.7% of the samples, mild expression in 13.3%–40.0%, moderate expression in 0%–33.3%, and severe expression in none of the samples (P<0.001).
Conclusions: Ki-67 was either moderately or severely overexpressed in the majority of odontogenic keratocyst samples. The 2017 WHO classification, which reclassifies keratocystic odontogenic tumors as cysts, conflicts with our findings.
To the Editor:
We found the letter from Dr Munusamy and co-workers, titled “Optimizing Recovery in Oral Flap Surgeries: The Undervalued Role of Physiotherapy,” of great value and interest. The letter comprehensively addresses the true outcomes of a surgically treated oral cancer patient, mostly adjunct with postoperative radiotherapy.
