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Rambam Maimonides Medical Journal

Helen Senderovich, Akash Yendamuri
INTRODUCTION: Dyspnea is prominently observed in palliative care (PC). Dyspnea can be multifactorial, primarily caused by obstructive or restrictive lung diseases or secondarily induced by various comorbidities. Numerous interventions exist, with route of administration and efficacy requiring further discussion. Despite opioids being the first line of treatment, their adverse effects lead to reluctance on the side of patients to take them, creating limitations in patient management planning...
October 16, 2018: Rambam Maimonides Medical Journal
Abhijit Nair, Veena Enagandula Amula, Vibhavari Naik, Praveen Kumar Kodisharapu, Anne Poornachand, M S Shyam Prasad, Mohammed Salman Saifuddin, Basanth Kumar Rayani
BACKGROUND AND AIMS: Multimodal analgesia comprising opioid, paracetamol, and non-steroidal anti-inflammatory drugs is used for managing postoperative surgical pain after ileostomy closure (IC). We investigated the efficacy of unilateral dual transversus abdominis plane (TAP) block to reduce morphine consumption in the first 24 hours along with a reduction in visual analogue score for pain and in postoperative nausea/vomiting. METHODS: This was a single-center, investigator-initiated, prospective, parallel-group, placebo-controlled randomized study involving patients undergoing IC under general anesthesia...
October 4, 2018: Rambam Maimonides Medical Journal
Ziv Gil, Shuli Brammli-Greenberg
In recent years, it has become increasingly important to improve efficiency and economic balance in hospitals. The department chairperson (or Chair) contends with a production function consisting of inputs and outcomes, rife with managerial constraints. These constraints can be reduced with proper management by diverting resources and activity. Lack of a proper management algorithm at the department level is a significant impediment to improving operational efficiency in hospitals without significant additional costs...
October 4, 2018: Rambam Maimonides Medical Journal
Eyal Bercovich, Marcia C Javitt
Today medical imaging is an essential component of the entire health-care continuum, from wellness and screening, to early diagnosis, treatment selection, and follow-up. Patient triage in both acute care and chronic disease, imaging-guided interventions, and optimization of treatment planning are now integrated into routine clinical practice in all subspecialties. This paper provides a brief review of major milestones in medical imaging from its inception to date, with a few considerations regarding future directions in this important field...
October 4, 2018: Rambam Maimonides Medical Journal
Marc J Kahn, Benjamin P Sachs
By their very nature both man-made and natural disasters are unpredictable, and so we recommend that all health-care institutions be prepared. In this paper, the authors describe and make a number of recommendations, regarding the importance of crisis and turnaround management using as a model the New Orleans public health system and Tulane University Medical School post-Hurricane Katrina. Leadership skills, articulation of vision, nimble decision making, and teamwork are all crucial elements of a successful recovery from disaster...
October 4, 2018: Rambam Maimonides Medical Journal
Jesse Lachter, Carly Rosenberg, Tomer Hananiya, Iyad Khamaysi, Amir Klein, Kamel Yassin, Elizabeth Half
OBJECTIVE OF THE WORK: Pancreatic cancer (PC) is a deadly disease that is most commonly diagnosed at an incurable stage. Early diagnosis is the most important factor for improving prognosis. Evidence is beginning to accumulate that screening and surveillance may lead to the early detection of precursor lesions and/or pancreatic cancer in asymptomatic individuals. Proper screening methods and identification of such precursor lesions may enable effective pre-emptive interventions to prevent further fatalities...
October 4, 2018: Rambam Maimonides Medical Journal
Gilat Grunau, Shai Linn
BACKGROUND: Overall accuracy measures of medical tests are often used with unclear interpretations. OBJECTIVES: To develop methods of calculating the overall accuracy of medical tests in the patient population. METHODS: Algebraic equations based on Bayes' theorem. RESULTS: A new approach is proposed for calculating overall accuracy in the patient population. Examples and applications using published data are presented...
October 4, 2018: Rambam Maimonides Medical Journal
Cecilia P Labardini, Eytan Z Blumenthal
Intravitreal injection of anti-vascular endothelial growth factor is currently the preferred treatment for several posterior segment diseases, including age-related macular degeneration and diabetic retinopathy, as well as macular edema and retinal vein occlusion. As an invasive procedure it involves risks. The most significant risk is infectious endophthalmitis, a sight-threatening and even a globe-threatening acute fulminant condition. Most common pathogens include Streptococcus and Staphylococcus species, surprisingly originating from the patient's, surgeon's, or nurse's mouth...
September 2, 2018: Rambam Maimonides Medical Journal
Nehama Zuckerman-Levin, Haleema Dabaja-Younis, Elemy Ameer, Michal Cohen, Yasmin Maor, Naim Shehadeh
OBJECTIVES: Research and theory suggests that socioeconomic status may affect diabetes control. We investigated the effect of socioeconomic status and ethnicity on glycated hemoglobin (HbA1c) in Arab and Jewish children with type 1 diabetes mellitus in northern Israel. METHODS: Data were collected from medical records of 80 Arab and 119 Jewish children attending a pediatric diabetes clinic in a tertiary health care center. Multivariate regression analysis was used to assess factors independently affecting HbA1c level...
September 2, 2018: Rambam Maimonides Medical Journal
Yona Nadir, Benjamin Brenner
Cancer patients have a pro-thrombotic state attributed to the ability of cancer cells to activate the coagulation system and interact with hemostatic cells, thus tilting the balance between pro- and anticoagulants. Mechanisms underlying the coagulation system activation involve tumor cells, endothelial cells, platelets, and white blood cells. Anti-cancer therapies, including anti-angiogenic drugs, significantly increase the risk of thrombosis during treatment. Along with the role of coagulation proteins in the hemostatic system, these proteins also serve as growth factors to the tumor...
September 2, 2018: Rambam Maimonides Medical Journal
Oz Mordechai, Myriam Weyl-Ben-Arush
OBJECTIVE: To date, the understanding of pediatric tumor genomics and how these genetic aberrations correlate with clinical outcome is lacking. Here, we report our experience with the next-generation sequencing (NGS) test program and discuss implications for the inclusion of molecular profiling into clinical pediatric oncology trials. We also aimed to explore studies on NGS in pediatric cancers and to quantify the variability of finding actionable mutations and the clinical implications...
July 30, 2018: Rambam Maimonides Medical Journal
Dekel Shilo, Omri Emodi, Ori Blanc, Dani Noy, Adi Rachmiel
Three-dimensional (3D) printing is based on additive technology in which layers of materials are gradually placed to create 3D objects. The world of 3D printing is a rapidly evolving field in the medical industry as well as in most sectors of our lives. In this report we present current technological possibilities for 3D printing in the surgical field. There are different 3D printing modalities and much confusion among clinicians regarding the differences between them. Three-dimensional printing technologies can be classified based on the basic material used: solid, liquid, and powder...
July 30, 2018: Rambam Maimonides Medical Journal
Or Cohen-Inbar, Gil E Sviri
The surgical management of cerebral and skull base lesions has evolved greatly in the last few decades. Still, a complete resection of lesions abutting critical neurovascular structures carries significant morbidity. Stereotactic radiosurgery (SRS) has emerged as an increasingly accepted treatment option. Minimally invasive, SRS results in excellent tumor control and low complication rates in patients with moderate-size tumors. The management of large cerebral and skull base tumors remains a formidable challenge...
July 30, 2018: Rambam Maimonides Medical Journal
Amir Kugelman, Liron Borenstein-Levin, Huda Jubran, Gil Dinur, Shlomit Ben-David, Elena Segal, Julie Haddad, Fanny Timstut, Iris Stein, Imad R Makhoul, Ori Hochwald
Iatrogenesis is more common in neonatal intensive care units (NICUs) because the infants are vulnerable and exposed to prolonged intensive care. Sixty percent of extremely low-birth-weight infants are exposed to iatrogenesis. The risk factors for iatrogenesis in NICUs include prematurity, mechanical or non-invasive ventilation, central lines, and prolonged length of stay. This led to the notion that "less is more." In the delivery room delayed cord clamping is recommended for term and preterm infants, and suction for the airways in newborns with meconium-stained fluid is not performed anymore...
July 30, 2018: Rambam Maimonides Medical Journal
Rafael Beyar, Karl Skorecki, Shraga Blazer
No abstract text is available yet for this article.
July 30, 2018: Rambam Maimonides Medical Journal
Laura Bar-David, Eytan Z Blumenthal
Glaucoma is a chronic neurodegenerative optic nerve disease. Treatment is intended to prevent the development and progression of optic nerve damage by lowering intraocular pressure (IOP). Current therapy options include topical/systemic drugs that increase aqueous humor outflow or decrease its production, laser therapy that targets the trabecular meshwork and ciliary body, and incisional surgery. Trabeculectomy as well as glaucoma drainage devices are often performed, given their high efficacy in lowering IOP...
July 30, 2018: Rambam Maimonides Medical Journal
George M Weisz, Konrad Kwiet
Despite daunting circumstances, history is full of stories of men and women incarcerated by the Nazis, who risked their lives to save others. In some cases, the moral dilemma faced by these people presented an unquestionable challenge-particularly for those in the medical profession who had taken an oath to save life. This paper presents the dramatic stories of Dr. Gisella Perl and Dr. Erno Vadasz. Although their choices were markedly different, their goals were the same-to save as many lives as possible.
July 30, 2018: Rambam Maimonides Medical Journal
Karin Weiss, Alina Kurolap, Tamar Paperna, Adi Mory, Maya Steinberg, Tova Hershkovitz, Nina Ekhilevitch, Hagit N Baris
OBJECTIVE: The growing availability of next-generation sequencing technologies has revolutionized medical genetics, facilitating discovery of causative genes in numerous Mendelian disorders. Nevertheless, there are still many undiagnosed cases. We report the experience of the Genetics Institute at Rambam Health Care Campus in rare disease diagnostics using whole-exome sequencing (WES). METHODS: Phenotypic characterization of patients was done in close collaboration with referring physicians...
July 30, 2018: Rambam Maimonides Medical Journal
Amir Minerbi, Simon Vulfsons
BACKGROUND: The energy crisis hypothesis, which is a widely accepted model for the pathogenesis of myofascial pain, has been corroborated by experimental observations. However, the nature of the insult leading to the energy crisis remains elusive. A commonly cited model for this insult is the Cinderella hypothesis, suggesting that hierarchical recruitment of motor units leads to a disproportional load on small units, thus driving them towards an energy crisis. New findings cast doubt on this model, showing that in postural muscles motor units are recruited in rotation, rather than in a hierarchical order, precluding the formation of the so-called Cinderella units...
July 30, 2018: Rambam Maimonides Medical Journal
Claudia Grajeda-Iglesias, Michael Aviram
The strong relationship between cardiovascular diseases (CVD), atherosclerosis, and endogenous or exogenous lipids has been recognized for decades, underestimating the contribution of other dietary components, such as amino acids, to the initiation of the underlying inflammatory disease. Recently, specific amino acids have been associated with incident cardiovascular disorders, suggesting their significant role in the pathogenesis of CVD. Special attention has been paid to the group of branched-chain amino acids (BCAA), leucine, isoleucine, and valine, since their plasma values are frequently found in high concentrations in individuals with CVD risk...
July 30, 2018: Rambam Maimonides Medical Journal
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