Winter 2023

Original Articles

Immature Platelets and Platelet Reactivity in Patients with COVID-19

Yulia Balmakov BMSc1*, Tomer Mark MD2,3*, Itzik Barnett MHA2,3, Michal Cipok PHD3,4, Eli I. Lev MD3,5, Eliad Aviram MD MHA3, Ami Mayo MD2,3 6-11
Background: Coronavirus disease 2019 (COVID-19) is associated with a high incidence of thromboembolic events, both venous and arterial. Currently, there are no clinical or laboratory markers to guide antithrombotic therapy in COVID-19 patients. Immature platelets represent a population of hyper-reactive platelets associated with arterial thrombotic events.
Objectives: To determine indices of immature platelets and platelet reactivity in COVID-19 patients.
Methods: This prospective study compared consecutive severe COVID-19 patients (n=53, median age=73 years) versus patients with sepsis from another origin (n=41, median age=69 years). Total platelet counts, immature platelet fraction (IPF), and immature platelet count (IPC) were determined by the Sysmex XN- 3000 auto-analyzer on admission and at subsequent time points.
Results: IPC levels three days after admission were significantly higher in the COVID-19 group compared to the sepsis group (13.4 × 10⁹/ L [IQR 9.1-18.5] in the COVID-19 group vs 9× 10⁹/ L [5.5-14.7] in the sepsis group, P=0.007). Furthermore, platelet count three days post-admission and a week after admission were also higher in the COVID-19 group compared to the sepsis group, though this difference was not quite significant one week after admission (256 × 10⁹/ L [IQR 177-369] in the COVID-19 group vs 179× 10⁹/ L [128.5-229.5] in the control group, P=0.002; and 313× 10⁹/ L [IQR 219.5-371] in the COVID-19 group vs 261× 10⁹/ L [IQR 169-338.5] in the control cohort, P=0.058).
Conclusions: COVID-19 patients had higher total platelet counts three days and a week after admission compared to septic patients. Additionally, the COVID-19 group had significantly higher IPC levels three days after admission than the non-Covid sepsis group, which is known to have hyper-reactive platelets and enhanced platelet turnover. Interestingly, while the platelet indices (IPC and platelet count) remained elevated during hospitalization, CRP (C-reactive protein) levels decreased. These findings suggest that immature platelets may serve as a biomarker for disease severity in COVID‐19 patients and their CRP may not be a reliable marker for disease severity.

IInfluenza Vaccination in Children with Pulmonary Disease during the COVID-19 Pandemic

Nofar Amitai MD1,2*, Reut Wertheimer BMSc3*, Dario Prais MD1,2, Keren-Or Wertheimer BMSc3, Gilat Livni MD1,2 14-21
Background: Influenza is associated with considerable respiratory morbidity and mortality. Healthcare authorities recommend immunization of all children as vaccination protects vulnerable populations and minimizes influenza-triggered asthma attacks. During the SARS-CoV-2 pandemic, it reduced the burden of respiratory illnesses. Medical professionals should counsel parents of children with chronic lung disease to receive annual influenza vaccinations as part of supportive care.
Objectives: We assessed adherence to influenza vaccination in respiratory patients and identified potential reasons for non-vaccination.
Methods: Parents of patients who visited the Pediatric Pulmonary Institute at Schneider Children’s Medical Center with their children during March-August 2021 were asked to complete questionnaires reviewing their personal experience and beliefs regarding influenza vaccination.
Results: Of 198 parents who completed our questionnaire, 114 (57.3%) vaccinated their children against influenza during that year. Average age of the children was 6.9±4.5 years. Demographic data were similar between the vaccinated and unvaccinated groups. Influenza vaccination rates differed significantly between parents who received an explanation from their primary physician and those who did not (65.4% vs. 43.7%, respectively, p=0.003), and parents who received explanations from a pulmonary specialist and those who did not (77.3% vs. 48.8%, respectively, p=0.004). The combined recommendation of a primary physician and pulmonologist translated to a significantly higher vaccination rate among those who received such recommendations compared to those who did not (p<0.001). Parents who believed in vaccine efficacy and safety were more likely to vaccinate their children (p<0.001). Factors significantly affecting the decision of the parents to have their child vaccinated were their knowledge, beliefs, and conceptions about the vaccine.
Conclusions: Pediatric respiratory patients’ influenza vaccination rate was 57%. Major factors encouraging vaccination were correct parental knowledge and receiving recommendations from their primary physician/pulmonologist. This emphasizes the need to provide patients with information by first explaining the vaccine’s importance to physicians and then emphasizing the importance of recommending the vaccine to patients.

The Significance of Laboratory Inflammatory Indices in Children with Acute Appendicitis: A Retrospective Follow-up Study.

Ali Tarabeih MD1,2,*, Mahmud Omar MD2,*, Doua Bakry MD2,3, Bian Hino MD2,3, Alon Yulevich MD1,3 22-28
Background: Acute appendicitis is the most common urgent surgical problem in children.
Objectives: This study aimed to investigate the correlation between the clinical course of early acute appendicitis and laboratory inflammatory indices.
Methods: We conducted a retrospective follow-up study of children with acute appendicitis at Ziv Medical Center between 01.01.2015 and 31.12.2019. Participants were identified using the medical center's computerized records system, and a physician reviewed their medical records. All data were transferred to a computerized system for summary and statistical analysis.
Results: The study included 300 children with an average age of 11 years. The average hospitalization duration was three days, with 65% being males and 35% being females. The average time from the onset of pain to the emergency room presentation was 24 hours. Laboratory inflammation indices included an average white blood cell count (WBC) level of 13.7, an average neutrophil percentage of 73%, and an average C-reactive protein (CRP) level of 34.6. The positive predictive value combining the three inflammatory indices was 88.6, while the negative predictive value was 75.
Conclusions: Children who presented to the emergency room later in the course of the disease had significantly higher levels of WBC, neutrophils, and CRP. In children with abdominal pain that started over 24 h previously, localized sensitivity in the lower right abdomen, and high inflammatory indices (WBC, neutrophil levels, and CRP), there is a high suspicion of acute appendicitis. However, these tests cannot be used to diagnose acute appendicitis in patients with shorter illness duration.

Review Articles

Broca's Area and its Relevance in the Modern Era

Ella Hazan Bsc1, Zvi. R Cohen MD2, Tehila Kaisman-Elbaz MD PhD BPT2 28-37
Background: Broca's area was discovered in 1861 by Dr. Pierre Paul Broca and has been extensively studied since. It has been found to have a greater role in speech and language function than initially thought. In addition, extensive research in the speech and language field revealed the complexity of the process of human speech, with Broca's area, while highly significant, being merely one aspect. Lately, some studies have claimed that Broca's area was successfully removed without inducing a marked language deficit. Here, we comprehensively review the knowledge gained and studies conducted in multiple aspects of this field.
Methods: We screened the available literature by searching acceptable medical search engines including PubMed and Google Scholar. We identified 49 relevant papers in the fields of neuroanatomy and neurosurgery, focusing on research of Broca's area, and speech and language processes, as well as those concerning language mapping and awake craniotomy conducted to safely resect tumors located in those areas. We also present a case of a young patient with low-grade glioma located within Broca's area to emphasize the challenges of surgical treatment, which is the standard of care in those cases.
Results: Broca's area’s anatomical and functional definition has been refined since its discovery. The anatomical and functional network of language is detailed. Low-grade gliomas, which are a common cause of language deficits in the young population are described, as well as their treatment of choice - tumor resection, which is specifically challenging due to the proximity to brain areas involved in speech. These procedures are, therefore, mostly done awake and under direct electrophysiological monitoring.
Conclusions: Speech and language processes are complex, but in some cases, brain plasticity seems to enable the resection of essential areas without causing a significant language deficit. More research is needed regarding brain plasticity and techniques to maximize its benefit to patients about to undergo tumor resection.

Vegan Diet and Male Fertility - A Systematic Literature Review

Antoni Skripai BSc1,2, Elad Babayof BSc1,2 38-43
Background: There is a growing interest in the possible connection between a vegan diet and male fertility due to the worldwide surge in the popularity of vegan diets and the global decline of sperm parameters. Although some studies suggest that a vegan diet may positively impact male fertility, other studies have found contradicting evidence.
Objectives: This literature review aims to assess the effect of a vegan diet on various aspects of male fertility based on current studies. The article's objective is to review the existing literature on the impact of a vegan diet on male sperm, hormones, and other sexual functions.
Methods: We performed a systematic review searching PubMed® to identify studies investigating the impact of a vegan diet on male fertility. Relevant studies were identified and reviewed.
Results: Some aspects of fertility appear to improve under a vegan diet. Adherence to a vegan diet has been found to correlate with a significant increase in sperm count and overall sperm motility. However, there are contradicting findings regarding sperm concentration, morphology, and viability, with some studies suggesting improvement while others are the opposite.
Conclusions: Overall, a majority of studies suggest that a vegan diet could have a positive impact on male fertility. However further research is needed to explore the impact of a vegan diet on male fertility as current research is far from comprehensive and has conflicting findings.

Letters To The Editor

On What Evidence are you Basing your Medicine?

Netanel Gelkop BMSc1, Alexander Kiderman MD2 44-45

Between Leonardo da Vinci and ChatGPT

Anne Krinsky BMedSc 46-50


The Light

נריה יעקב 52