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Zloof Y, Derazne E, Braun M, Friedland R, Scheuerman O, Shlaifer A, Goldberg L. Hyperhidrosis and Hypermobility Spectrum Disorders Among Adolescents. JAMA Dermatol 2024; 160:572-573. [PMID: 38536154 PMCID: PMC10974676 DOI: 10.1001/jamadermatol.2024.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/16/2024] [Indexed: 05/16/2024]
Abstract
This cross-sectional study assesses the prevalence and risk of excessive sweating and joint hypermobility in Israeli adolescents aged 16 to 19 years.
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Affiliation(s)
- Yair Zloof
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
- Department of Preventive Medicine and Epidemiology, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatrics B, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel
| | - Estela Derazne
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Maya Braun
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Rivka Friedland
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Pediatric Dermatology Unit, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel
| | - Oded Scheuerman
- Department of Pediatrics B, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amir Shlaifer
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
- Department of Military Medicine, Hebrew University, Jerusalem, Israel
| | - Lotem Goldberg
- Department of Pediatrics B, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Tiruneh A, Radomislensky I, Shlaifer A, Talmy T, Almog O, Rotschield J, Katorza E, Benov A, Avital G. The Association Between ADHD in Adolescence and Injury in Early Adulthood in Israel: A Nationwide Historical Cohort Study. J Atten Disord 2024:10870547241246482. [PMID: 38659313 DOI: 10.1177/10870547241246482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
OBJECTIVE To examine the association between late adolescence ADHD and the risk of serious injury in early adulthood. METHOD A nationwide cohort study utilizing data from the Military Health Examinations Database for potential military recruits (age 16.5-18 years), cross-referenced with the Israeli National Trauma Registry (2008-2020). Individuals with and without ADHD (mild/severe) were compared for early adulthood injury risk using Cox models. RESULTS This study compared 76,403 participants with mild ADHD (18.76%) and 330,792 without (81.24%), alongside 2,835 severe ADHD participants (1.11%) versus 252,626 without (98.89%). Adjusted hazard ratios for injury-related hospitalization were 1.27 (95% CI [1.17, 1.37]) for mild ADHD and 1.40 (95% CI [1.09, 1.79]) for severe ADHD, compared to non-ADHD. CONCLUSIONS Adolescents with ADHD, regardless of severity, had a significantly higher risk of hospitalization due to injury that persists into early adulthood, underscoring the importance of recognizing ADHD as an injury risk and incorporating it into injury prevention strategies.
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Affiliation(s)
- Abebe Tiruneh
- The National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Irina Radomislensky
- The National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Israel Defense Forces Medical Corps, Tel-Hashomer, Ramat Gan, Israel
| | - Amir Shlaifer
- Israel Defense Forces Medical Corps, Tel-Hashomer, Ramat Gan, Israel
| | - Tomer Talmy
- Israel Defense Forces Medical Corps, Tel-Hashomer, Ramat Gan, Israel
- Department of Military Medicine, Faculty of Medicine, Hebrew University, Jerusalem 9574869, Israel
| | - Ofer Almog
- Israel Defense Forces Medical Corps, Tel-Hashomer, Ramat Gan, Israel
- Department of Military Medicine, Faculty of Medicine, Hebrew University, Jerusalem 9574869, Israel
| | - Jacob Rotschield
- Israel Defense Forces Medical Corps, Tel-Hashomer, Ramat Gan, Israel
- Department of Military Medicine, Faculty of Medicine, Hebrew University, Jerusalem 9574869, Israel
| | - Eldad Katorza
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Gertner Institute for Epidemiology & Health policy Research, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Arrow Program for Medical Research Education, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Avi Benov
- Israel Defense Forces Medical Corps, Tel-Hashomer, Ramat Gan, Israel
- The Azrieli Faculty of Medicine Bar Ilan University, Safed, Israel
| | - Guy Avital
- Israel Defense Forces Medical Corps, Tel-Hashomer, Ramat Gan, Israel
- Division of Anesthesia, Intensive Care and Pain Management, Tel-Aviv Sourasky Medical Center, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Schermann H, Schiffmann N, Ankory R, Shlaifer A, Yavnai N, Yoffe V, Natapov L. Methylphenidate use and restorative treatment needs in young adults with attention deficit hyperactivity disorder. Spec Care Dentist 2024; 44:556-562. [PMID: 37288998 DOI: 10.1111/scd.12885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/09/2023] [Accepted: 05/20/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To assess the effect and dose-response of methylphenidate (MP) use on the restorative treatment needs in young adults with attention deficit hyperactivity disorder. PARTICIPANTS AND METHODS This retrospective study comprises a cohort of military recruits aged 18-25 who served for 12 to 48 months between 2005 and 2017. The medical records of 213 604 participants were assessed of which: 6875 participants with ADHD who received treatment with MP, 6729 participants with ADHD who had no prescriptions for MP, and 200 000 healthy participants. The outcome was restorative treatment needs, which served as an indicator of caries: having at least one prescription for restorative treatment during the study period. RESULTS Frequency of prescription for restorative treatment among the treated, the untreated and the control groups was 24%, 22%, and 17%, respectively (p < .0001). On multivariate analysis, the dose-response association between MP use and the odds of having at least one restorative treatment was confirmed (OR = 1.006 for each additional 1 gr of MP; 95% CI [1.004:1.009]) CONCLUSIONS: Participants with ADHD who receive chronic treatment with MP have higher restorative treatment needs than participants with untreated ADHD and healthy participants. Our results show that chronic MP medication among young adults leads to an elevated need for restorative treatment and implies a significant impact on oral health (OH).
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Affiliation(s)
- Haggai Schermann
- Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Nathan Schiffmann
- Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Israel Defense Forces Medical Corps, Tel Hashomer, Israel
| | - Ran Ankory
- Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
- Israel Defense Forces Medical Corps, Tel Hashomer, Israel
| | - Amir Shlaifer
- Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
- Israel Defense Forces Medical Corps, Tel Hashomer, Israel
| | - Nirit Yavnai
- Israel Defense Forces Medical Corps, Tel Hashomer, Israel
| | - Victoria Yoffe
- Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
- Israel Defense Forces Medical Corps, Tel Hashomer, Israel
| | - Lena Natapov
- Division of Dental Health, State of Israel Ministry of Health, Jerusalem, Israel
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Tsur N, Zloof Y, Rittblat M, Reuven Y, Simchoni M, Derazne E, Yitzchaki Z, Adler L, Shlaifer A, Manuva O, Beer Z. Hearing Impairment and Severe Attention Deficit/Hyperactivity Disorder: A Nationwide Study. Otol Neurotol 2024; 45:e142-e146. [PMID: 38238915 DOI: 10.1097/mao.0000000000004092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
BACKGROUND The association between hearing impairment and attention-deficit/hyperactivity disorder (ADHD) is unclear. Therefore, we aimed to assess this association in Israel's national sample of over 1.1 million adolescents. METHODS We conducted a nationwide, population-based, cross-sectional study of all Israeli adolescents (n = 1,175,534, 58% males; mean age, 17 yrs) who were examined before mandatory military service during 2004 to 2020. Board-certified specialists confirmed diagnoses of hearing impairment and severe ADHD. MAIN OUTCOMES AND MEASURES We compared the prevalence of severe ADHD in adolescents with and without hearing impairment. Associations were analyzed using logistic regression models and sensitivity analyses accounting for hearing impairment type (sensorineural vs. conductive) and severity. RESULTS Of the 8,769 adolescents with hearing impairment, 57 were diagnosed with severe ADHD (prevalence = 0.65%). Of the 1,166,765 adolescents without hearing impairment, 3,936 were diagnosed with severe ADHD (prevalence = 0.29%). We found a significant association between hearing impairment and severe ADHD (odds ratio = 1.93 [95% confidence interval, 1.47-2.49]), which persisted in a multivariable model adjusted to age, sex, socioeconomic status, educational status, cognitive performance, and immigration status (odds ratio = 1.70 [95% confidence interval, 1.29-2.20]). The association also persisted when stratified by hearing impairment type (sensorineural vs. conductive) and severity. CONCLUSIONS Adolescents with hearing impairment had 70% increased odds of severe ADHD. Study findings suggest that active screening of patients with hearing impairment for ADHD should be considered.
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Affiliation(s)
| | | | | | | | - Maya Simchoni
- Department of Child Neurology and Development Schneider Children's Medical Center, Petah Tikva, Israel
| | - Estela Derazne
- Department of Military Medicine, Hebrew University, Jerusalem, Israel
| | | | - Lior Adler
- Department of Child Neurology and Development Schneider Children's Medical Center, Petah Tikva, Israel
| | | | - Omer Manuva
- Department of Military Medicine, Hebrew University, Jerusalem, Israel
| | - Zivan Beer
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
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Zloof Y, Peretz L, Braun M, Simchoni M, Tsur AM, Tzur D, Derazne E, Ben-Tov A, Pinhas-Hamiel O, Amarilyo G, Daher S, Shlaifer A, Braun-Moscovici Y. Hypermobility spectrum disorders and irritable bowel syndrome: A nationwide study of 1.6 million adolescents. J Gastroenterol Hepatol 2023; 38:2076-2082. [PMID: 37658800 DOI: 10.1111/jgh.16341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 08/02/2023] [Accepted: 08/16/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND AND AIM The association between hypermobility spectrum disorders/hypermobile type Ehlers-Danlos syndrome (HDS/hEDS) and irritable bowel syndrome (IBS) is yet to be clarified. We aimed to assess this association in a national sample of adolescents. METHODS A population-based cross-sectional study included 1 627 345 Israeli adolescents (58% male; mean age 17 years) who were medically assessed before compulsory military service during 1998-2020. Diagnoses of HSD/hEDS and IBS were confirmed by board-certified specialists. The prevalence and odds ratios (ORs) for IBS in adolescents with and without HSD/hEDS were computed. RESULTS A total of 4686 adolescents (2553 male) with HSD/hEDS were identified, of whom 71 were diagnosed with IBS (prevalence = 1.5%). Of the 1 621 721 adolescents in the control group, 8751 were diagnosed with IBS (prevalence = 0.5%). Unadjusted logistic regression revealed a significant association between HSD/hEDS and IBS (OR = 2.16 [95% confidence interval, CI, 1.90-2.45]), which persisted in multivariable adjusted models (OR = 2.58 [95% CI, 2.02-3.24]), and in several sensitivity analyses. The association was evident in both male and female adolescents with ORs of 2.60 (95% CI, 1.87-3.49), and 2.46 (95% CI, 1.66-3.49), respectively. The association was accentuated in a sensitivity analysis accounting for other medical and psychiatric comorbidities. CONCLUSIONS We found a significant association between HSD/hEDS and IBS in both male and female adolescents. Clinical awareness of the association can promote early diagnosis of IBS and appropriate multidisciplinary treatment. Further research is required to identify the common pathological pathways of the conditions and to develop new IBS treatment strategies for people with HSD/hEDS.
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Affiliation(s)
- Yair Zloof
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
- Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Department of Preventive Medicine and Epidemiology, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Lidor Peretz
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Maya Braun
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Maya Simchoni
- Department of Military Medicine, Hebrew University, Jerusalem, Israel
| | - Avishai M Tsur
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
- Department of Preventive Medicine and Epidemiology, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Military Medicine, Hebrew University, Jerusalem, Israel
- Department of Medicine, Sheba Medical Center, Ramat Gan, Israel
| | - Dorit Tzur
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Estela Derazne
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amir Ben-Tov
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Pediatric Gastroenterology Unit, Dana-Dwek Children's Hospital, Sourasky Medical Center, Tel Aviv, Israel
| | - Orit Pinhas-Hamiel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Pediatric Endocrinology and Diabetes Unit, Edmond and Lili Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Gil Amarilyo
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Pediatric Rheumatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Saleh Daher
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
- Institute of Gastroenterology and Liver Diseases, Department of Medicine, Hadassah-University Hospital, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Amir Shlaifer
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
- Department of Military Medicine, Hebrew University, Jerusalem, Israel
| | - Yolanda Braun-Moscovici
- B Shine Rheumatology Institute, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Zloof Y, Simchoni M, Derazne E, Tsur AM, Tzur D, Braun M, Amarilyo G, Shlaifer A, Honig A, Braun-Moscovici Y. Hypermobility spectrum disorders and active migraine in Israeli adolescents: A nationwide study. Headache 2023. [PMID: 37313588 DOI: 10.1111/head.14526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To assess the association between hypermobility spectrum disorders/hypermobile type Ehlers Danlos Syndrome (HSD/hEDS) and migraine in a national sample of adolescents in Israel. BACKGROUND The association between HSD/hEDS and migraine is unclear, even more so in pediatric populations. METHODS This population-based, cross-sectional study included 1,627,345 Israeli adolescents (945,519/1,626,407 [58%] males; mean age 17 ± 0.5 years) who were medically assessed before mandatory military service during 1998-2020. Diagnoses of migraine with at least one attack per month (active migraine) and HSD/hEDS were confirmed by certified specialists. The prevalences of active migraine in adolescents with and without HSD/hEDS were computed and the association between HSD/hEDS and active migraine was examined. RESULTS Active migraine was significantly more prevalent in adolescents with HSD/hEDS (307/4686 [6.5%]) compared to those without HSD/hEDS (51,931/1,621,721 [3.2%]) (OR = 2.16, 95% CI 1.90-2.45). The association between HSD/hEDS and active migraine persisted in a multivariable analysis (OR = 2.08, 95% CI 1.85-2.34) and in several sensitivity analyses. CONCLUSIONS We found a significant association between HSD/hEDS and active migraine in both male and female adolescents. Clinical awareness of the association can promote early diagnosis and treatment of migraine. Further research is required to identify appropriate pharmacologic and nonpharmacologic migraine treatment strategies for individuals with HSD/hEDS.
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Affiliation(s)
- Yair Zloof
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
- Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Department of Preventive Medicine and Epidemiology, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maya Simchoni
- Department of Military Medicine, Hebrew University, Jerusalem, Israel
| | - Estela Derazne
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avishai M Tsur
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
- Department of Preventive Medicine and Epidemiology, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Military Medicine, Hebrew University, Jerusalem, Israel
- Department of Medicine, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Dorit Tzur
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Maya Braun
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Gil Amarilyo
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Rheumatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Amir Shlaifer
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
- Department of Military Medicine, Hebrew University, Jerusalem, Israel
| | - Asaf Honig
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yolanda Braun-Moscovici
- B Shine Rheumatology Institute, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Peretz L, Grossman A, Saeed SJ, Appleboim-Refael T, Zloof Y, Friedensohn L, Shapira S, Shlaifer A, Grotto I. Association between SARS-CoV-2 infection and the physical fitness of young-adult cadets: a retrospective case-control study. BMJ Open 2022; 12:e066094. [PMID: 36517094 PMCID: PMC9755906 DOI: 10.1136/bmjopen-2022-066094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To determine the association of symptomatic and asymptomatic mild COVID-19 and the SARS-CoV-2 viral load with the physical fitness of army cadets. DESIGN A retrospective case-control study. SETTING Officers' Training School of the Israel Defense Forces. PARTICIPANTS The study included all cadets (age, 20.22±1.17 years) in the combatant (n=597; 514 males, 83 females; 33 infected, all males) and non-combatant (n=611; 238 males, 373 females; 91 infected, 57 females, 34 males) training courses between 1 August 2020 and 28 February 2021. COVID-19 outbreaks occurred in September 2020 (non-combatants) and January 2021(combatants). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measures were the aerobic (3000 m race) and anaerobic (combatant/non-combatant-specific) physical fitness mean score differences (MSDs) between the start and end of the respective training courses in infected and non-infected cadets. Secondary outcome measures included aerobic MSD associations with various COVID-19 symptoms and SARS-CoV-2 viral loads. RESULTS SARS-CoV-2 infection led to declined non-combatant and combatant aerobic fitness MSD (14.53±47.80 vs -19.19±60.89 s; p<0.001 and -2.72±21.74 vs -23.63±30.92 s; p<0.001), but not anaerobic. The aerobic physical fitness MSD decreased in symptomatic cadets (14.69±44.87 s) and increased in asymptomatic cadets (-3.79±31.07 s), but the difference was statistically insignificant (p=0.07). Symptomatic cadets with fever (24.70±50.95 vs -0.37±33.87 s; p=0.008) and headache (21.85±43.17 vs 1.69±39.54 s; p=0.043) had more positive aerobic physical fitness MSD than asymptomatic cadets. The aerobic fitness decline was negatively associated with viral load assessed by the RNA-dependent RNA polymerase (n=61; r = -0.329; p=0.010), envelope (n=56; r = -0.385; p=0.002) and nucleus (n=65; r = -0.340; p=0.010) genes. CONCLUSIONS SARS-CoV-2 infection was associated with a lingering decline in aerobic, but not anaerobic, fitness in symptomatic and asymptomatic young adults, suggesting possible directions for individualised symptom-dependent and severity-dependent rehabilitation plans' optimisation.
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Affiliation(s)
- Lidor Peretz
- Israel Defense Forces, Israeli Medical Corps, Tel Hashomer, Tel Aviv, Israel
| | - Akiva Grossman
- Israel Defense Forces, Israeli Medical Corps, Tel Hashomer, Tel Aviv, Israel
- Combat Fitness Department, Israel Defense Forces, Tel Hashomer, Tel Aviv, Israel
- Department of Epidemiology, Biostatistics, and Community Health Sciences, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer Sheva, Israel
| | - Salih J Saeed
- Israel Defense Forces, Israeli Medical Corps, Tel Hashomer, Tel Aviv, Israel
| | | | - Yair Zloof
- Israel Defense Forces, Israeli Medical Corps, Tel Hashomer, Tel Aviv, Israel
- Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
| | - Limor Friedensohn
- Israel Defense Forces, Israeli Medical Corps, Tel Hashomer, Tel Aviv, Israel
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center Institute of Endocrinology, Tel HaShomer, Israel
| | - Shachar Shapira
- Israel Defense Forces, Israeli Medical Corps, Tel Hashomer, Tel Aviv, Israel
- Military Medicine and "Tzameret", Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
| | - Amir Shlaifer
- Israel Defense Forces, Israeli Medical Corps, Tel Hashomer, Tel Aviv, Israel
- Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
| | - Itamar Grotto
- Department of Epidemiology, Biostatistics, and Community Health Sciences, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer Sheva, Israel
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Satanovsky A, Gilor Y, Benov A, Chen J, Shlaifer A, Talmy T, Radomislensky I, Siman-Tov M, Peleg K, Weil YA, Eisenkraft A. Combat Injury Profile in Urban Warfare. Mil Med 2022:usac366. [PMID: 36454618 DOI: 10.1093/milmed/usac366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/19/2022] [Accepted: 11/07/2022] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION Combat ground maneuvers consist of various platforms and have several environmental characteristics, influenced by the terrain, the operational mission, and the force's capabilities. This study assesses data on injuries sustained during urban warfare, aiming to evaluate the relationship between injury characteristics, maneuver platform, and personal protective gear on the battlefield. MATERIALS AND METHODS IDF soldiers injured infantry soldiers from the "Cast Lead" and the "Protective Edge" operations in the Gaza Strip (2008-2009 and 2014, respectively) were divided into four groups according to the maneuver platform and the environment: mounted infantry (armored and unarmored vehicle) and dismounted infantry (urban and open area). The primary outcome was the severity of the injury, and the secondary outcome was the injured body part. RESULTS Overall, 588 casualties were included in the final analysis, of whom 507 were dismounted infantry soldiers (265 in open terrain and 242 in urban area) and 81 were mounted infantry soldiers (20 in unarmored and 61 were injured in armored vehicles). The Injury Severity Score was similar in all subgroups. Open terrain subgroups were found to have fewer head injuries and higher levels of lower extremity injuries, similar to the unarmored vehicle group. More facial injuries were documented in the urban area group. CONCLUSIONS The Injury Severity Score was not influenced by environmental protection. Although we found differences in the injured body parts, further studies on the exact mechanism of injury are needed to elucidate further the relationship and differences between the various platforms used and injuries seen in urban warfare, aiming for tailor-made protection.
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Affiliation(s)
- Alexandra Satanovsky
- The Israel Defense Force Medical Corps Headquarters, Ramat Gan 5262000, Israel
- Orthopaedic Department, Hadassah Hebrew University Hospital, Jerusalem 91120, Israel
| | - Yuval Gilor
- The Institute for Research in Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Force Medical Corps, Jerusalem 91120, Israel
| | - Avi Benov
- The Israel Defense Force Medical Corps Headquarters, Ramat Gan 5262000, Israel
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Jacob Chen
- The Israel Defense Force Medical Corps Headquarters, Ramat Gan 5262000, Israel
- Deputy Director General of the medical center, Meir Medical Center, Kfar Saba 4428163, Israel
| | - Amir Shlaifer
- The Israel Defense Force Medical Corps Headquarters, Ramat Gan 5262000, Israel
| | - Tomer Talmy
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Irina Radomislensky
- The Israel National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel HaShomer, Ramat Gan 5266202, Israel
| | - Maya Siman-Tov
- The Israel National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel HaShomer, Ramat Gan 5266202, Israel
- The Department of Emergency Management and Disaster Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel
| | - Kobi Peleg
- The Israel National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel HaShomer, Ramat Gan 5266202, Israel
- The Department of Emergency Management and Disaster Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel
| | - Yoram A Weil
- Orthopaedic Department, Hadassah Hebrew University Hospital, Jerusalem 91120, Israel
| | - Arik Eisenkraft
- The Institute for Research in Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Force Medical Corps, Jerusalem 91120, Israel
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Mitchnik IY, Talmy T, Radomislensky I, Chechik Y, Shlaifer A, Almog O, Gendler S. Femur fractures and hemorrhagic shock: Implications for point of injury treatment. Injury 2022; 53:3416-3422. [PMID: 36041921 DOI: 10.1016/j.injury.2022.08.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/19/2022] [Accepted: 08/21/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Femur shaft fractures (FSF) are perceived as potentially life-threatening injuries due to significant blood loss. However, these injuries are rarely the sole cause of hemorrhagic shock. Clinical practice guidelines for the prehospital management of FSF are inconsistent, especially concerning the use and timing of traction splinting which is postulated to reduce bleeding. We sought to understand the association between FSF and shock, and identify risk factors for shock among casualties with FSF. METHODS This is a retrospective analysis of trauma casualties treated by Israeli Defense Forces (IDF) medical teams between the years 2000-2020 and suffering from isolated FSF. Prehospital data from the IDF-Medical Corps Trauma Registry was merged with hospitalization data from the Israeli National Trauma Registry. Isolated FSF was analyzed by excluding casualties with an Injury Severity Score ≥ 16 and an Abbreviated Injury Scale ≥ 3 in other anatomical regions. Shock was defined as systolic blood pressure ≤ 90 mmHg and/or heart rate ≥ 130 beats per minute. A case series review was performed for casualties in shock with isolated FSF injuries. Multivariable logistic regression was performed to assess for injury characteristics associated with shock. RESULTS During the study period, we identified 213 patients with FSF (4.9%) of which 129 were isolated injuries. Overall, 9.9% and 26.3% of casualties had concurrent thoracic and abdominal injuries, respectively. Most FSF were due to motor vehicle accidents (60.1%) and shock was present in 17.1%. In isolated FSF patients, gunshot and explosive injury mechanisms were prevalent (65.0%) with severe shock being present in 8.5%. Open fractures were present in 72.7% of isolated FSF patients in shock. Open FSF injuries were characterized by prehospital bleeding which was difficult to control. In a multivariable logistic regression model, severe concomitant injuries were associated with increased odds of shock. CONCLUSIONS Shock rarely presents when FSF is the primary injury. Such casualties predominantly suffer from open FSF which may present as difficult to control thigh bleeding. Our findings do not support urgent prehospital leg traction splinting which may result in delayed evacuation to definitive care. Casualties with shock and FSF should be investigated for other sources of bleeding. Leg traction splinting should be reserved for suspected FSF injuries with shock or persistent thigh bleeding.
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Affiliation(s)
- Ilan Y Mitchnik
- Israel Defense Force Medical Corps, Tel Hashomer, Israel; Department of Military Medicine, Hebrew University, Jerusalem, Israel; Department of Orthopedic Surgery, Shamir Medical Center, Zrifin, Israel.
| | - Tomer Talmy
- Israel Defense Force Medical Corps, Tel Hashomer, Israel; Department of Military Medicine, Hebrew University, Jerusalem, Israel; Trauma and Combat Medicine Branch, Israel Defense Force Medical Corps, Tel Hashomer, Israel
| | - Irina Radomislensky
- Trauma and Combat Medicine Branch, Israel Defense Force Medical Corps, Tel Hashomer, Israel; The National Center for Trauma & Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel HaShomer, Israel
| | - Yigal Chechik
- Israel Defense Force Medical Corps, Tel Hashomer, Israel; Department of Orthopedic Surgery, Shamir Medical Center, Zrifin, Israel
| | - Amir Shlaifer
- Israel Defense Force Medical Corps, Tel Hashomer, Israel
| | - Ofer Almog
- Israel Defense Force Medical Corps, Tel Hashomer, Israel; Department of Military Medicine, Hebrew University, Jerusalem, Israel; Trauma and Combat Medicine Branch, Israel Defense Force Medical Corps, Tel Hashomer, Israel
| | - Sami Gendler
- Israel Defense Force Medical Corps, Tel Hashomer, Israel; Trauma and Combat Medicine Branch, Israel Defense Force Medical Corps, Tel Hashomer, Israel
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Sofer-Sali N, Roif-Kaminsky D, Motro Y, Khalfin B, Avramovich E, Galor I, Shlaifer A, Sommer A, Rutenberg R, Sachter Y, Itzhak A, Grupel D, Moran-Gilad J. Prevalence and characteristics of carriage of Neisseria meningitidis among young Israeli adults. Open Forum Infect Dis 2022; 9:ofac482. [PMID: 36225741 PMCID: PMC9547516 DOI: 10.1093/ofid/ofac482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background No updated data currently exist regarding Neisseria meningitidis carriage and genomic epidemiology among young Israeli adults. Methods Oropharyngeal swabs were collected from 1801 military recruits on the day of recruitment during 2019. Neisseria meningitidis was detected and identified by culture and quantitative polymerase chain reaction (qPCR). Confirmed isolates were serotyped by qPCR, and encapsulated strains underwent whole-genome sequencing. Risk factors for carriage were determined by analyzing focused questionnaires using uni- and multivariate models. Genomic typing was performed by means of core genome multilocus sequence typing. Results Carriage rates overall and of encapsulated strains were 20.1% and 6.7%, respectively. Genogroups B (49.2%) and Y (26.7%) were the most commonly encapsulated strains. Genogroups C, W, and X were scarce, and genogroup A was absent. The most notable clonal complexes (CCs) were CC23 (n = 30), CC32 (n = 16), and CC44/41 (n = 9). Carriage was significantly associated with smoking (odds ratio [OR], 1.82; 95% CI, 1.43–2.33) and boarding school attendance before recruitment (OR, 1.49; 95% CI, 1.14–1.96). Conclusions The prevalence of meningococcal carriage among young Israeli adults is high, compared with similar studies in other developed countries. This might be due to sociocultural characteristics including smoking and boarding school attendance during and after high school. The dominant genogroups and CCs found were compatible with those implicated in invasive disease in Israel.
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Affiliation(s)
- Noa Sofer-Sali
- Braun school of Public Health and Community Medicine, The Hebrew University of Jerusalem-Hadassah Medical Organization Jerusalem , Israel
| | - Diana Roif-Kaminsky
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev , Beer Sheva , Israel
| | - Yair Motro
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev , Beer Sheva , Israel
| | - Boris Khalfin
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev , Beer Sheva , Israel
| | | | - Inbal Galor
- Israel Defense Forces Medical Corps , Israel
| | | | - Adir Sommer
- Department of Ophthalmology, Rambam Health Care Campus , Haifa , Israel
| | - Ran Rutenberg
- Emergency Department, Beilinson Hospital, Rabin Medical Center , Petah Tikva , Israel
| | | | - Avi Itzhak
- Surgery Division, Soroka University Medical Center , Beer Sheva , Israel
| | - Daniel Grupel
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev , Beer Sheva , Israel
- Department of Internal medicine B, Soroka University Medical Center , Beer Sheva , Israel
| | - Jacob Moran-Gilad
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev , Beer Sheva , Israel
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Rittblat M, Gavish L, Tsur AM, Gelikas S, Benov A, Shlaifer A. Intraosseous administration of freeze-dried plasma in the prehospital setting. Isr Med Assoc J 2022; 24:591-595. [PMID: 36168178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Freeze dried plasma (FDP) is a commonly used replacement fluid in the prehospital setting when blood products are unavailable. It is normally administered via a peripheral intravenous (PIV) line. However, in severe casualties, when establishing a PIV is difficult, administration via intraosseous vascular access is a practical alternative, particularly under field conditions. OBJECTIVES To evaluate the indications and success rate of intraosseous administration of FDP in casualties treated by the Israel Defense Forces (IDF). METHODS A retrospective analysis of data from the IDF-Trauma Registry was conducted. It included all casualties treated with FDP via intraosseous from 2013 to 2019 with additional data on the technical aspects of deployment collected from the caregivers of each case. RESULTS Of 7223 casualties treated during the study period, intravascular access was attempted in 1744; intraosseous in 87 of those. FDP via intraosseous was attempted in 15 (0.86% of all casualties requiring intravascular access). The complication rate was 73% (11/15 of casualties). Complications were more frequent when the event included multiple casualties or when the injury included multiple organs. Of the 11 failed attempts, 5 were reported as due to slow flow of the FDP through the intraosseous apparatus. Complications in the remaining six were associated with deployment of the intraosseous device. CONCLUSIONS Administration of FDP via intraosseous access in the field requires a high skill level.
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Affiliation(s)
- Mor Rittblat
- Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel
| | - Lilach Gavish
- Institute for Research in Military Medicine (IRMM) of The Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Forces Medical Corps
| | - Avishai M Tsur
- Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel
- Departments of Medicine B, Sheba Medical Center, Tel Hashomer, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shaul Gelikas
- Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
| | - Avi Benov
- Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Amir Shlaifer
- Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel
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Kazum E, Rath E, Shlaifer A, Sharfman ZT, Martin HD, Eizenberg G, Reider E, Amar E. Preemptive analgesia in hip arthroscopy: intra-articular bupivacaine does not improve pain control after preoperative peri-acetabular blockade. Hip Int 2022; 32:265-270. [PMID: 32866047 DOI: 10.1177/1120700020950247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Literature addressing postoperative pain management after hip arthroscopy is relatively scarce. This study aimed to assess if there was added analgesic benefit associated with postoperative intra-articular bupivacaine blockade for patients who received preoperative peri-acetabular blockade for hip arthroscopy procedures. METHODS 52 patients were included in this comparative cohort study. Group 1 consisted of 20 patients who received preoperative peri-acetabular blockade and postoperative intra-articular blockade. The control group (Group 2), consisted of 32 patients who received only preoperative peri-acetabular blockade. Postoperative pain was recorded via visual analogue scale (VAS) pain scores, analgesic consumption, and pain diaries for 2 weeks postoperatively. RESULTS Postoperative VAS pain scores were significantly lower in the experimental group at the 30-minute recovery room assessment (VAS scores Group 1: 1.1; Group 2: 3.00, p = 0.034). Other than the 30-minute recovery room assessment, VAS pain scores, narcotic medication consumption, and non-narcotic analgesic consumption did not differ between the 2 groups at any time point in the study period. CONCLUSIONS This study did not demonstrate significant clinical benefit for patients who receive postoperative intra-articular blockade in addition to preoperative peri-acetabular blockade with bupivacaine 0.5%. We recommend the use of preoperative peri-acetabular bupivacaine blockade without intra-articular blockade postoperatively for pain control in the setting of hip arthroscopy surgery.
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Affiliation(s)
- Efi Kazum
- Department of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Rath
- Department of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Shlaifer
- Department of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zachary T Sharfman
- Department of Orthopedic Surgery, Montefiore Medical Center and The Albert Einstein College of MedicineBronx, NY, USA
| | - Hal D Martin
- Hip Preservation Center, Baylor University Medical Center, Dallas, TX, USA
| | - Gilad Eizenberg
- Department of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Evgeny Reider
- Department of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Amar
- Department of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Shlaifer A, Siman-Tov M, Radomislensky I, Peleg K, Klein Y, Glassberg E, Yitzhak A. The impact of prehospital administration of freeze-dried plasma on casualty outcome. J Trauma Acute Care Surg 2020; 86:108-115. [PMID: 30358770 DOI: 10.1097/ta.0000000000002094] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hemorrhage is the most common preventable cause of death in both civilian and military trauma. There is no consensus regarding the appropriate fluid resuscitation protocol. Plasma, as a resuscitative fluid, has substantial benefits as a volume expander, owing to its relatively high oncotic pressure and its positive effect on trauma-induced coagulopathy by replenishing the lost coagulation factors, rather than diluting the casualty's remaining factors. The Israel Defense Force Medical Corps decided to use freeze-dried plasma (FDP) as the fluid of choice for casualties in hemorrhagic shock in the prehospital setting. The aim of our study is to compare the differences of coagulation, perfusion measurements, resource utilization, and outcome between casualties receiving FDP to casualties who did not receive FDP in the prehospital setting. METHODS This is a retrospective matched cohort study based on two groups of casualties (those treated with FDP vs. those without FDP treatment). The control group was compiled in three steps of precision for age, sex, mechanism of injury and maximum level of severity for each nine injured body regions. Data were collected from the IDF Trauma Registry and The National Israel Trauma Registry. RESULTS The study group comprised 48 casualties receiving FDP and 48 controls with no differences in demographic, evacuation time, and injury characteristics. The FDP group demonstrated a lower level of hemoglobin (12.7 gr/dzl) (odds ratio [OR], 3.11; 95% confidence interval [CI], 1.10-8.80), lower level of international normalized ratio (1.1) (OR, 3.09; 95% CI, 1.04-9.14), and lower level of platelets (230 × 109/L) (OR, 3.06; 95% CI, 1.16-8.06). No other differences were found between the two groups. CONCLUSION The use of FDP in the prehospital setting has logistic benefits and a positive effect on coagulation profile, with no other significant effects. Future studies need to be performed on larger groups to verify trends or nullify our hypotheses. LEVEL OF EVIDENCE Therapeutic, level IV.
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Affiliation(s)
- Amir Shlaifer
- From the The Israel Defense Forces Medical Corps, Tel-Hashomer, Israel (S.A., G.E., Y.A.); Israel National Center for Trauma and Emergency Medicine (S.-T.M., R.I., P.K.), Gertner Institute for Epidemiology and Public Health Policy, Tel-Hashomer, Israel; Department of Disaster Management (P.K.), School of Public Health, Tel Aviv University, Tel Aviv, Israel; Division of Trauma and Emergency Surgery, Department of Surgery (K.Y.), Sheba Medical Center, Ramat-Gan, Israel; The Uniformed Services (G.E.), University of the Health Sciences, Bethesda, MD and Bar-Ilan University Faculty of Medicine (G.E.), Safed, Israel
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Fedida B, Schermann H, Ankory R, Rotman D, Shichman I, Yoffe V, Shlaifer A, Luger E. Fracture risk of young adults receiving proton-pump inhibitors and H2-receptor antagonists. Int J Clin Pract 2019; 73:e13339. [PMID: 30829427 DOI: 10.1111/ijcp.13339] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/24/2019] [Accepted: 03/02/2019] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Proton-pump inhibitors (PPI) and histamine (type 2) receptor antagonists (H2RA) have the potential to interfere with calcium metabolism. Several authors have evaluated the effect of these medications on fracture incidence in older adults. A recent large epidemiologic study demonstrated a higher risk of fractures in young adults receiving PPI. AIM To evaluate the effect of PPI and H2RA use on fracture incidence in a large retrospective cohort of military recruits representative of general population of young adults. METHODS A retrospective cohort of 254 265 male and 234 670 female non-combat military conscripts ages 18-25. Subjects were divided into three groups by PPI use (no PPI use, 1-100 tablets and more than 100 tablets) and two groups by H2RA use (no H2RA use, any H2RA use). Multivariate logistic regression was used to adjust fracture risk for age, BMI, education level, socio-economic level, ethnic origin, occupation and duration of follow-up in months. MAIN OUTCOME MEASURES At least one fracture during the study period. RESULTS Use of PPI and H2RA was not associated with an increased risk of fractures. In men, the predictors of an increased fracture risk were higher BMI (OR = 1.007, P < 0.001), origin from a developing country (OR = 1.15, P < 0.001) and service as a driver (OR = 1.11, P < 0.001). Higher education, higher socioeconomic status and service as an officer or as an administrative worker had a protective effect on fracture incidence. In women, fractures were associated with higher BMI (OR = 1.035, P < 0.001). Origin from a developed country, as well as service as an officer or an administrative worker was associated with lower fracture risk. CONCLUSIONS There was no association between the use of PPI or H2-antagonists and fracture incidence in this retrospective cohort of healthy young military recruits.
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Affiliation(s)
- Benjamin Fedida
- Division of Orthopedics, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Haggai Schermann
- Division of Orthopedics, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Ran Ankory
- Division of Orthopedics, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
- Medical Corps, Israeli Defence Forces, Tel Aviv, Israel
| | - Dani Rotman
- Division of Orthopedics, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Ittai Shichman
- Division of Orthopedics, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Vicky Yoffe
- Division of Orthopedics, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Amir Shlaifer
- Division of Orthopedics, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
- Medical Corps, Israeli Defence Forces, Tel Aviv, Israel
| | - Elhanan Luger
- Division of Orthopedics, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
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Schermann H, Ankory R, Shlaifer A, Dolkart O, Rotman D, Yoffe V, Karakis I, Chechik O. Lower risk of stress fractures in young adults with ADHD under chronic treatment with methylphenidate. Bone 2019; 120:20-24. [PMID: 30267775 DOI: 10.1016/j.bone.2018.09.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 09/08/2018] [Accepted: 09/25/2018] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Methylphenidate (MP) use is highly prevalent among children and young adults. Previous basic and epidemiological research demonstrated an adverse effect of MP on bone mass. Studies in military recruits have shown that history of MP use before conscription was a risk factor for stress fractures (SF) during the service. METHODS This study is part of the project in which the association between MP use and incidence of SF was retrospectively investigated in a cohort of healthy conscripts aged 18-25, who served for at least 12 months between 2008 and 2017. Baseline information included sex, age, weight, height, geographic origin, socioeconomic status, and education. Subjects were divided into five groups: subjects without ADHD; untreated subjects with ADHD; and subjects with ADHD and prescriptions of 1-90, 91-180, or 181+ tablets during the study period. The primary outcome was at least one diagnosis of stress fracture during the study. RESULTS Among 682,110 subjects (409,175 men [60%]), 29,888 (4.4%) had fractures. MP was used by 1681 (0.4%) men and 2828 (1%) women. In both men and women, SF incidence was significantly higher among subjects with untreated ADHD (7.9% and 5.4%, respectively) and significantly lower in subjects with treated ADHD (1.9-3%; 0.3-4.3%), compared to healthy controls (5.3% and 2.9%). After multivariate adjustment, subjects with untreated ADHD remained at an increased risk of fracture (men OR = 1.66, p < 0.001 and women OR = 1.33, p = 0.007), whereas only subjects with highest exposure to MP (180+ tablets) had significantly lower chances for fracture (men OR = 0.49, p = 0.08 and women OR = 0.09, p = 0.02), compared to healthy controls. DISCUSSION The study has demonstrated lower risk of stress fractures with concurrent MP use. The findings in this population challenge our understanding of the MP effect on bone integrity and prompt further basic research.
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Affiliation(s)
- Haggai Schermann
- Division of Orthopedics, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel.
| | - Ran Ankory
- Division of Orthopedics, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Amir Shlaifer
- Division of Orthopedics, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Oleg Dolkart
- Division of Orthopedics, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Dani Rotman
- Division of Orthopedics, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Vicky Yoffe
- Division of Orthopedics, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Isabella Karakis
- Environmental Epidemiology Department, Public Health Services, Ministry of Health, Israel; Ashkelon Academic College, Ashkelon, Israel
| | - Ofir Chechik
- Division of Orthopedics, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel
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Schermann H, Karakis I, Ankory R, Kadar A, Yoffe V, Shlaifer A, Yanovich R. Musculoskeletal Injuries Among Female Soldiers Working With Dogs. Mil Med 2018; 183:e343-e348. [PMID: 29788209 DOI: 10.1093/milmed/usy105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/30/2018] [Accepted: 04/26/2018] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Female soldiers serving in the Israeli Defense Forces canine unit may be at increased risk of overuse injuries related to working with military dogs. We hypothesized that this particular type of occupational exposure may lead to an increased strain of the upper extremity due to such non-physiologic motions as pulling the dog's strap or resisting the sudden pulling by the dog, and may result in an increased rate of overuse injuries. MATERIALS AND METHODS We compared incidence of overuse injuries in a retrospective cohort of female soldiers who served either in the military working dogs' unit (MWD), or in the light infantry battalions (Infantry) from 2005 to 2015. We compared injury incidence of both groups during two periods: 5 mo of basic training (neither worked with dogs) and 19 or more months of combat service. Incidence was calculated as number of diagnoses per person-months (rate ratios, RR); each diagnosis counted once per study subject. We used RR confidence intervals to compare incidence of injuries between groups. RESULTS There were 3,443 person-months in the MWD group and 194,590 person-months in the Infantry group. There was no difference in injury incidence between groups during the initial period of basic training. During the second period, MWDs had higher incidence of upper limb (RR = 1.45, p = 0.048) and hip (RR = 3.6, p < 0.0001) injuries. The association between service with dogs and upper limb injuries remained significant (RR = 1.09, p = 0.005) after adjusting for confounding variables in the multivariate regression analysis. Other independent predictors of the upper limb overuse injuries included each additional month of service (RR = 1.003, p = 0.008), Eastern European origin compared with Israeli-born recruits (RR = 0.97, p = 0.03), increased body weight in increments of 10 kg (RR = 1.008, p = 0.03), anemia (RR = 1.02, p = 0.02) and fatigue (RR = 1.05, p ≤ 0.0001). CONCLUSIONS We found that service in the MWD unit was associated with increased risk of upper limb injuries. Identification of the exact mechanism of injury and targeted interventions, as well as treatment of anemia and fatigue may lead to reduction of injuries in this unit.
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Affiliation(s)
- Haggai Schermann
- Department of Orthopedic Surgery, Orthopedic Surgery Division, Tel Aviv Sourasky Medical Center Affiliated with Tel Aviv University, Tel Aviv, Israel.,Department of Military Physiology, Heller Institute of Medical Research, Sheba Medical Center Affiliated with Tel Aviv University, Ramat Gan, Israel
| | - Isabella Karakis
- Environmental Epidemiology Department, Public Health Services, Ministry of Health, Israel.,School of Health Professionals, Ashkelon Academic College, Ashkelon, Israel
| | - Ran Ankory
- Department of Orthopedic Surgery, Orthopedic Surgery Division, Tel Aviv Sourasky Medical Center Affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Assaf Kadar
- Department of Orthopedic Surgery, Orthopedic Surgery Division, Tel Aviv Sourasky Medical Center Affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Victoria Yoffe
- Department of Orthopedic Surgery, Orthopedic Surgery Division, Tel Aviv Sourasky Medical Center Affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Amir Shlaifer
- Department of Orthopedic Surgery, Orthopedic Surgery Division, Tel Aviv Sourasky Medical Center Affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Ran Yanovich
- Department of Orthopedic Surgery, Orthopedic Surgery Division, Tel Aviv Sourasky Medical Center Affiliated with Tel Aviv University, Tel Aviv, Israel.,Unit of Military Physiology, The Warrior Health Research Institute, Israel Defense Forces, Medical Corps, Tel Hashomer, Israel
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Yanovich R, Karakis I, Ankory R, Yoffe V, Shlaifer A, Schermann H. Upper limb musculoskeletal overuse injuries among female soldiers working with dogs. J Sci Med Sport 2017. [DOI: 10.1016/j.jsams.2017.09.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bahouth H, Shlaifer A, Yitzhak A, Glassberg E. Helping hands across a war-torn border: the Israeli medical effort treating casualties of the Syrian Civil War. Lancet 2017; 389:2579-2583. [PMID: 28495107 DOI: 10.1016/s0140-6736(17)30759-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 01/10/2017] [Accepted: 01/16/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Hany Bahouth
- Departments of General Surgery and Acute Care Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Amir Shlaifer
- The Israel Defense Forces, Medical Corps, Surgeon General Head Quarters, Ramat Gan, Israel
| | - Avraham Yitzhak
- The Israel Defense Forces, Medical Corps, Surgeon General Head Quarters, Ramat Gan, Israel
| | - Elon Glassberg
- The Israel Defense Forces, Medical Corps, Surgeon General Head Quarters, Ramat Gan, Israel; Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel; Department of Surgery at Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
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Schermann H, Eiges N, Sabag A, Kazum E, Albagli A, Salai M, Shlaifer A. Estimation of Dog-Bite Risk and Related Morbidity Among Personnel Working With Military Dogs. J Spec Oper Med 2017; 17:51-54. [PMID: 28910468 DOI: 10.55460/2f8x-fnzf] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/01/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Soldiers serving in the Israel Defense Force Military Working Dogs (MWD) Unit spend many hours taming dogs' special skills, taking them on combat missions, and performing various dogkeeping activities. During this intensive work with the aggressive military dogs, bites are common, and some of them result in permanent disability. However, this phenomenon has not been quantified or reported as an occupational hazard. METHODS This was a retrospective cohort study based on self-administered questionnaires. Information was collected about soldiers' baseline demographics, duration of the experience of working with dogs, total number of bites they had, circumstances of bite events, and complications and medical treatment of each bite. Bite risk was quantified by incidence, mean time to first bite, and a Cox proportional hazards model. Rates of complications and the medical burden of bites were compared between combat soldiers and noncombat dogkeepers. Bite locations were presented graphically. RESULTS Seventy-eight soldiers participated and reported on 139 bites. Mean time of working with dogs was 16 months (standard deviation, ±9.4 months). Overall bite incidence was 11 bites per 100 person-months; the mean time to first bite event was 6.3 months. The Cox proportional hazards model showed that none of baseline characteristics significantly increased bite hazard. About 90% of bites occurred during routine activities, and 3.3% occurred on combat missions. Only in 9% of bite events did soldiers observed the safety precautions code. Bite complications included fractures, need for intravenous antibiotic treatment and surgical repair, prominent scarring, diminished sensation, and stiffness of proximal joints. Bite complications were similar between combat soldiers and dogkeepers. Most bites (57%) were located on hands and arms. CONCLUSION MWD bites are an occupational hazard resulting in significant medical burden. Hands and arms were most common bite locations. Observance of safety precautions may be the most appropriate first-line preventive intervention. Barrier protection of upper extremities may reduce bite severity and complication rates.
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Shina A, Baruch EN, Shlaifer A, Shovali A, Levi M, Yosefy O, Segal D, Bader T, Shavit I, Yitzhak A. Comparison of Two Intraosseous Devices: The NIO Versus the EZ-IO by Novice Users-A Randomized Cross Over Trial. PREHOSP EMERG CARE 2016; 21:315-321. [PMID: 27870553 DOI: 10.1080/10903127.2016.1247201] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND During resuscitation in the field, intraosseous (IO) access may be achieved using a variety of available devices, often attempted by inexperienced users. AIM We sought to examine the success rate and ease-of-use ratings of an IO device, the NIO® (New Intraosseous Persys Medical, Houston, TX, USA) in comparison to the Arrow® EZ-IO® (Teleflex Medical Research Triangle Park, NC, USA) by novice users. METHODS We performed a randomized crossover trial. The study model was a porcine hind leg which was cut distally in order to expose the marrow. The Study population was composed of pre-graduate medical students without prior experience in IO use, all designated future field physicians. The students underwent instruction and practiced the use of both devices. After practice completion, each student attempted a single IO insertion with both devices sequentially in randomized fashion. Success was defined as a flow of fluid through the bone marrow after a single IO attempt. Investigators which determined the success rate were blinded to the used device. RESULTS 50 users (33 males, 17 females) participated in the trial, mean age of 21.7 years (±1). NIO users were successful in 92% (46/50) attempts while EZ-IO user success rate was 88% (44/50). NIO success rates were comparable to those of EZ-IO (p = NS). Results were similar when examining only the initial device used. Median score of ease of use was 4 (5 point Likert scale) in both devices (p = NS). 54% (27/50) of the participants preferred using the EZ-IO over the NIO (p = NS). CONCLUSION Novice users were equally successful in establishing IO access with the NIO® in comparison to the EZ-IO® in a porcine model.
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Baruch EN, Kragh JF, Berg AL, Aden JK, Benov A, Shina A, Shlaifer A, Ahimor A, Glassberg E, Yitzhak A. Confidence–Competence Mismatch and Reasons for Failure of Non-Medical Tourniquet Users. PREHOSP EMERG CARE 2016; 21:39-45. [DOI: 10.1080/10903127.2016.1209261] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Shlaifer A. A review of glaucoma literature. Am J Optom Arch Am Acad Optom 1971; 48:113-20. [PMID: 5277464 DOI: 10.1097/00006324-197102000-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Shlaifer A. A review of glaucoma literature. Am J Optom Arch Am Acad Optom 1970; 47:3-18. [PMID: 4904602 DOI: 10.1097/00006324-197001000-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Shlaifer A. A review of recent literature on glaucoma. Am J Optom Arch Am Acad Optom 1967; 44:471-89. [PMID: 4864481 DOI: 10.1097/00006324-196708000-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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