Objective: Starvation in early life can cause poor bone health and metabolic aberrations in bone minerals, leading to abnormal bone development. Holocaust survivors have been exposed to starvation and malnutrition before and during World War II. This paper aims to provide the current state of knowledge on the osteoporosis risk in Holocaust survivors and their descendants.
Methods: The PubMed and Scopus databases were searched. Papers that reported original data on the risk of osteoporosis in Holocaust survivors and in their offspring were included in the study.
Results: Ten studies were included in this review. The majority of studies were case-control ones (n=7) versus two self-reported and one longitudinal study. Despite the limited cohort numbers and the small number of studies in the literature, the data showed a potential increased risk of osteoporosis in Holocaust survivors and especially in their descendants.
Conclusions: The review of these studies showed a higher prevalence of osteoporosis among Holocaust survivors and their offspring. Knowledge of the trans-generational inheritance of osteoporosis in the descendants of Holocaust survivors should increase the awareness of primary care health workers on osteoporosis screening and early diagnosis and implementation of preventive measures, including adequate vitamin D and calcium supplementation, and pharmacological treatment.
Objectives: This study aims to investigate the efficacy and outcomes of transurethral resection of the prostate (TURP) in the context of younger male patients.
Methods: Males aged ≤55 who underwent TURP at Rambam Health Care Campus from January 2011 to August 2023 were retrospectively reviewed. Clinicodemographic characteristics, indications for surgery, uroflowmetry, pressure-flow study, and early and late postoperative outcomes were collected. Patients with urethral or bladder abnormalities were excluded. Chi-square and Fisher’s exact tests were employed for bivariate analysis.
Results: Inclusion criteria were met by 58 men who underwent TURP at a median age of 52 years (interquartile range [IQR] 49.5–54). Median prostate size was 35 mL (24.5–56), with median prostate-specific antigen of 1.4 ng/mL (0.65–3.1). A total of 60% of patients used α-blockers, and 19% used 5α-reductase inhibitors pre-surgery. Overall, 54 (93.1%) had severe lower urinary tract symptoms (LUTS), with 34 (59%) being predominantly emptying and 20 (35%) storage. Most surgeries were performed for refractory LUTS in 38 (66%), followed by urinary retention in 16 (28%). At 6 weeks, 57 (98%) patients were catheter-free. The maximum flow rate and residual volume showed significant improvement from 9 mL/s to 21 mL/s (P=0.01), and from 171 mL to 61 mL (P=0.006), respectively. Pathology revealed benign prostatic hyperplasia in 53 (91.4%), and inflammation in 5 (8.5%). A total of 13 auxiliary procedures were required in 12 patients (20.7%) during follow-up: 7 transurethral bladder neck incisions, 3 re-TURP, 1 meatus widening, and 1 patient required artificial urinary sphincter implantation followed by simple cystectomy for end-stage bladder.
Conclusions: In young men, TURP showed short-term gains in flowmetry and catheter removal rates, but a sustained need for subsequent procedures in the long run. In this unique population, patients should be carefully selected, and alternative, less aggressive, interventions should be considered.
Background and Objective: Chronic low back pain disability (CLBPD) is a syndrome that includes pain, disability, emotional impairments, and social problems. The study was conducted to examine the effect of an inpatient rehabilitation program on the performance of everyday life tasks (daily activities), and report on pain in CLBPD patients with primary activities of daily living (ADL) deficits.
Methods: In a retrospective cohort study, demographic and clinical data were retrieved from records of inpatients admitted consecutively to the program. Scores of the Spinal Pain Independence Measure (SPIM) and of changes in reported pain levels were used to assess improvement in the performance of daily activities and pain reduction. T-tests were used to assess the significance of score changes. Spearman’s correlations and analysis of variance were used to assess relationships of SPIM gain and affecting factors.
Results: Ninety-nine patients were included. Daily task performance improved in 71 patients (71.7%). The SPIM score increased from 48.7 (SD 16.3) at admission to the rehabilitation program to 57.8 (SD 12.5) at discharge (P<0.001). The SPIM score at admission negatively affected SPIM gain (P<0.001). The SPIM gain was significant for admission SPIM scores of 50 or lower (P<0.05), but differences in SPIM scores were not as noticeable for patients with admission SPIM scores above 50. Relief in pain was reported in 59 patients (59.6%) and was not associated with function.
Conclusions: The multidisciplinary rehabilitation program, which improved function and provided limited pain relief in inpatients with CLBPD primary ADL deficits, can be effective for the most severe CLBPD cases.
Failed surgical treatment of anterior shoulder instability should be treated according to clinical principles similar to primary stabilization by addressing risk factors related to the damaged static glenohumeral stabilizers (labrum, capsule and its components, and bony damage to the humeral head and scapular glenoid). In relatively rare conditions when failed primary surgery involves patients with functionally low demands, conservative treatment by strengthening dynamic muscular stabilizers might be considered; otherwise, surgical revision should be strongly considered aimed at improving quality of life. Although the overall failure rate following primary and revision surgery is expected to be below 4%, it is clear that revision surgery is technically demanding. Therefore, the initial recognition and correction of the exact pathology causing glenohumeral instability is crucial to avoid failure of primary surgery and to facilitate the success of the revision procedure, if necessary.
The coronavirus disease-2019 (COVID-19) epidemic started in late 2019, and was upgraded to a pandemic on March 11, 2020 by the World Health Organization (WHO). Well established epidemiological models have been used over the last few months in an attempt to predict how the virus would spread. The predictions were frightening, and the resulting panic caused many governments to impose lockdowns or other severe restrictions, with lasting effects. This short paper discusses another way of looking at the spread of COVID-19, by focusing on the daily rate of infection, defined as the daily rate of increase in the number of infected persons. It is shown that the daily rate is monotonically decreasing, after a short initial period, in all countries, and that the pattern is similar in all countries. This appears to be a universal phenomenon. Based on these calculations, the April 1, 2020 data for Western Europe were sufficient to predict the beginning of the end of COVID-19 in that region before the end of that month.
At the time of writing, in July 2020, the COVID-19 pandemic has already inflicted dramatic international restrictions, including airports closing and limiting international travel. It has been suggested that re-opening of airports should involve and even rely on testing travelers for COVID-19. This paper discusses the methodology of estimating the detection and diagnostic accuracy of COVID-19 tests. It explains the clear distinction between the technical characteristics of the tests, the detection measures, and the diagnostic measures that have clinical and public health implications. It demonstrates the importance of the prevalence of COVID-19 in terms of determining the ability of a test to yield a diagnosis. We explain the methodology of evaluating diagnostic tests, using the predictive summary index (PSI), and the minimum number of tests that need to be performed in order to correctly diagnose one person, which is estimated by 1/PSI. In a population with low prevalence, even a high-sensitivity test may lead to a high percentage of false positive diagnoses, resulting in the need for multiple high-cost tests to achieve a correct diagnosis. Thus, basing a policy for opening airports on diagnostic testing, even with the best test for COVID-19, has some limits.
The COVID-19 pandemic is different from previous pandemic diseases in many ways. One of them relates to the literature. There is an exponential increase in the number of articles since April 2020. Also, and equally drastic, is how readily available they are to the general reader. It will be interesting to analyze (in the future) if advances in information age have played any significant role in the battle against our current pandemic.
Background: Adequate lymphadenectomy is an important factor affecting survival in gastric cancer patients. Retrieval and examination of at least 15 lymph nodes is recommended in order to properly stage gastric malignancies. The objectives of this study were to evaluate the proportion of patients undergoing inadequate lymphadenectomies and possible risk factors for inadequate surgery.
Methods: This was a retrospective study that included patients, 18 years and older, who underwent gastrectomies with oncologic intent in the Hillel Yaffe Medical Center. We analyzed the association of demographic, clinical, and pathological variables with adequate number of lymph nodes.
Results: The retrieval of less than 15 lymph nodes was reported in 51% (53/104) patients undergoing gastrectomies with oncologic intent. The extent of surgery was the only variable associated with inadequate lymphadenectomy on univariate analysis: subtotal/proximal versus total gastrectomy (P=0.047). Differ¬ences observed for previous surgery (P=0.193), T stage (P=0.053), N stage (P=0.051), and lymphovascular invasion (P=0.14) did not reach significance. Subtotal/proximal gastrectomy resulted in inadequate resec¬tion of lymph nodes in 56% of the patients, while this occurred in only 30% of the patients undergoing total gastrectomy (relative risk 1.865; 95% CI 0.93, 3.741). Logistic regression confirmed that only subtotal/prox¬imal versus total gastrectomy was associated with inadequate number of lymph nodes resected (P=0.043).
Discussion and Conclusion: In this study we analyzed the association of patient, tumor, and surgery-related factors on adequate lymphadenectomy in patients undergoing gastrectomies for possible gastric cancer. Larger extent of the surgery (total, rather than subtotal/proximal gastrectomy) was revealed to be the only indicator positively associated with adequate lymphadenectomy.
Glucocorticosteroid-induced osteoporosis (GIO) is the most common cause of secondary osteoporosis but is underdiagnosed and undertreated. Our aim in this communication is to review the literature on the implementation of current GIO prevention practices such as calcium and vitamin D supplementation with emphasis on the rheumatologists’ perspective relating to the need for development of novel GIO educational prevention measures.
Objective: Idiopathic eosinophilic vasculitis has been described in previous case series as a possible manifestation of hypereosinophilic syndrome (HES) in asthma-free patients. A rare disease, it can be classified as an eosinophilic-rich, necrotizing, systemic form of vasculitis that affects vessels of various sizes in these patients. This report shares our experience with the treatment of a patient with eosinophilic vasculitis.
Case Presentation: We present the case of a 45-year-old man who suffered from idiopathic HES manifesting as digital ulcers and peripheral ischemia of both the upper and lower limbs without the involvement of other systems. Diagnosis was made after excluding the primary and secondary causes of eosinophilia. The patient responded well to both corticosteroids and mepolizumab, an interleukin-5 inhibitor, as a corticosteroid-sparing therapy.
Conclusion: Our case of HES-associated vasculitis in an asthma-free patient supports previous reports describing this rare diagnosis of idiopathic eosinophilic vasculitis in recent years. We describe a good response to mepolizumab (interleukin-5 inhibitor) in our patient.
