In the management of malignant thyroid disorders, the standard primary treatment is thyroidectomy, a surgical resection of the thyroid gland. This procedure has been performed for over a century. Hence, it comes as no surprise that it is not only exceedingly well-described in the literature. This issue of Rambam Maimonides Medical Journal includes an article by Chaturvedi et al. that challenges the standard widely-practiced clinical inclination toward surgery as the first and best option for all patients with early thyroid cancer. This editorial discusses the issues raised by the authors and points out the importance of ongoing research to determine when standards of care should be modified in the light of low-risk disease.
Background: Transthyretin (TTR), also known as prealbumin, has been suggested as an indicator of protein and nutritional status.
Objective: The aim of this study was to examine the maternal and umbilical cord (UC) TTR in relation to intrauterine growth, and the serum TTR of preterm infants in relation to nutritional status and growth.
Methods: After application of exclusion criteria, 49 preterm infants (mean gestational age and birth-weight 32.9±2.9 weeks and 1822±556 g) were included in the study. Transthyretin was sampled at birth and on days 14, 28 or at discharge with growth parameters and nutritional laboratories.
Results: Mean UC and maternal TTR were positively correlated (8.5±2.4 mg/dL and 20.4±7.0 mg/dL, r=0.31, P=0.07). Umbilical cord TTR was neither an index of maturity nor of intrauterine growth. Umbilical cord TTR was higher in females (9.4±2.6 versus 7.6±1.8 mg/dL, P=0.015). Maternal TTR was lower in twin pregnancies (16.8±4.9 versus 22.5±7.3 mg/dL, P=0.007). Although TTR levels gradually increased over time in correlation with post-menstrual and chronological ages (r=0.24, P=0.011 and r=0.40, P<0.001, respectively), there was no correlation to weight gain (r=0.10, P=0.41), nutritional status, protein intake, or laboratories. The only significant correlations were between TTR and glucose and triglycerides levels (r=0.51, P<0.001 for both).
Conclusions: Although TTR levels increased over time, we could not demonstrate significant correlations between TTR and indices of the nutritional status in preterm infants at birth or during the neonatal course.
Food security and nutrition were major drivers of cultural evolution by enabling sociotypic development and communal living after the Neolithic agricultural revolution some 12,000 years ago. The sociotype unites concepts from the sciences and the humanities; in concert with the genotype it determines an individual’s phenotype (observable traits and behavior), and together they advance societal culture. As such, the sociotype relates to an individual’s dynamic interactions with the surrounding social environment through¬out life and comprises three domains: the Individual, Relationships, and Context. Nutrition affects each domain, respectively, by ensuring the following dimensions of food security: utilization (metabolic fuel and health); accessibility (physical and economic); and availability (the right to nutritious food for all citi¬zens). The sociotype is influenced by multiple factors, including diet–gene interactions, allostasis, micro¬biota, oxytocin, and culturally through mate selection, family bonds, social communication, political ideol¬ogies, and values. Food security, sociotypes, and culture form a complex adaptive system to enable coping with the circumstances of life in health and disease, to achieve sustainable development, and to eradicate hunger. The current geopolitical unrest highlights the absolutely critical role of this system for global security, yet many challenges remain in implementing this paradigm for society. Therefore, sustainable food security must be considered a fundamental human right and responsibility for safeguarding the survival and progress of the sociotypes of humankind (Homo cultures) worldwide.
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare systemic small-vessel disease, with heterogeneous clinical manifestations. While arthralgia and myalgia are common in the disease course, frank myositis is exceedingly rare. Immune-mediated necrotizing myopathy (IMNM) is a subtype of idiopathic inflammatory myopathies (IIMs), characterized by severe myositis. We report herein a case of prominent diffuse myositis with shared features of AAV and IMNM.
Objective: Cirrhotic cardiomyopathy (CCM) is associated with increased morbidity and mortality in patients with liver cirrhosis. Yet, it remains an under-diagnosed entity. Further, its relation to the severity of cirrhosis is contradictory. We conducted this study on an Indian population to determine the cardiac dysfunctions in cirrhosis of the liver and correlations with etiologies and cirrhosis severity.
Methods: This study enrolled patients with diagnosed liver cirrhosis without any cardiac disease or conditions affecting cardiac function. All participants were evaluated clinically, electrocardiographically, and echocardiographically. Cirrhosis severity was assessed by scores from the Model for End-stage Liver Disease (MELD) and Child–Turcotte–Pugh (CTP) tests. Cirrhotic cardiomyopathy was defined as diastolic dysfunction and/or systolic dysfunction with QT prolongation.
Results: Ninety-six patients were evaluated, and CTP-A stage of cirrhosis was found in 23 (24%), CTP-B in 42 (43.8%), and CTP-C in 31 (32.3%) cases. Systolic dysfunction was most frequent (P=0.014), and left ventricular ejection fraction was significantly reduced (P=0.001) in CTP-C stage of cirrhosis. Cirrhotic cardiomyopathy was found in 39.6% (n=38) of patients; CCM patients had significantly higher CTP scores (9.6±2.6 versus 8.3±2.3, P=0.012) as well as MELD scores (19.72±4.9 versus 17.41±4.1, P=0.015) in comparison to patients without CCM.
Conclusion: Cirrhotic cardiomyopathy has a positive relationship with the severity of cirrhosis. Systolic function declines with the severity of cirrhosis, and overt systolic dysfunction can be present, particularly in the advanced stage of cirrhosis of the liver.
Meir Dvorjetski was a Holocaust survivor, teacher, and historian. He is best remembered for his descriptions of the medicine practiced by the Nazis during World War II, as well as the diseases, disorders, syndromes, and deaths resulting from such practice—particularly, though not solely, on the Jewish race. Dvorjetski’s contributions to Holocaust research at Bar-Ilan University in Israel, his underground partisan work, his contributions to society, and his testimony at the Eichmann trial have all been well documented. However, his earlier years—including his survival of the Holocaust, and his less-known medical achievements and contributions to historical records regarding the Holocaust—have not been covered as thoroughly. These latter items are the focus of this paper, with a closing commentary on the relevance of his work for the 21st century.
In their article “Authorship Disputes in Scholarly Biomedical Publications and Trust in the Research Institution” in the July 2023 issue of RMMJ, Ashkenazi and Olsha examined the association between the prevalence of misattributed authorship and trust in the institution analyzing misconduct in their scholarly publications. The authors, appropriately, include “gift authorship” as one of the three principal deviations from appropriate authorship choices that they examined. In essence, gift or honorary authorship is listing an author on a scholarly publication for which that person’s contribution did not justify assigning authorship. This behavior has become commonplace.
We would like to thank Professor Marshall Lichtman for his letter, his interesting proposal, and using this venue to promote discussion of the topic. Professor Lichtman proposed a numerical calculation for authorship based on the authors’ perceptions of their relative contribution to a scientific publication, an idea also suggested by Jozsef Kovacs. The only limitation imposed by this system is that the total of all authors’ fractional contributions to any one publication equals no more than one. Lichtman’s interesting proposal serves as a disincentive to offer gift authorship to colleagues whose contributions were minimal, if they contributed at all.
It has been the policy of Rambam Maimonides Medical Journal to limit the number of editorials published. However, silence and standing on the sidelines is not an option in light of the atrocities and inhumanity we witnessed on October 7. The savagery of the Hamas massacre was executed indiscriminately upon children, women, older people (some of whom are Holocaust survivors), infants, and even medical professionals caring for the casualties. Currently, there are about 230 women, men, children, and babies being held hostage by Hamas; among them are cancer patients and others with serious disorders, doctors, and other medical professionals. We cannot rest and must address the plight of our hostages who are being held by terrorists motivated by hatred and showing no respect for life, whether that of their enemies, their own people, or even themselves. ...
Late-onset nasolacrimal duct obstruction (NLDO) as a result of inflammatory processes causing dacryostenosis is a common entity affecting mostly women. While a few mechanisms have been suggested as contributors to the expression of NLDO, the trigger for the inflammation remains mostly unknown. Familial predilection for this condition has not been previously reported. We present two families with multiple individuals affected with congenital or late-onset NLDO, describe the signs and symptoms of the affected individuals, and explore their medical history for any contributing factors. Family A, spanning four generations, included 7 female patients affected by late-onset NLDO. Family B, spanning two generations, included 8 individuals affected by either congenital or late-onset NLDO. This case series suggests a familial predisposition to NLDO, apparently with an autosomal dominant inheritance pattern. Further studies are needed to elucidate the molecular basis of this genetic predisposition.
