Original Articles
Clinical and Epidemiological Factors Affecting Donor Corneal Endothelial Cell Count
Eden Amir* MD MSc MHA, Dean David Lichter* BMSc MBA, Netanel Corem BMSc, and Abraham Solomon MD
6-12
Background:
Cornea donor shortage remains the critical barrier to meeting the demands for corneal transplantation. While advanced age and prior cataract surgery are known to decrease donor corneal quality, a system to optimize resource allocation based on predicting corneal suitability is lacking.
Objectives:
To identify factors affecting donor corneal endothelial cell count (ECC) in an Israeli eye bank, with a specific focus on the impact of the short death-to-retrieval time (DRT).
Methods:
A retrospective analysis was conducted on 611 donor corneas retrieved at Hadassah Medical Center between 2018 and 2022. Univariate and multivariate analyses were employed to identify factors associated with adequate ECC for transplantation (defined here as ECC≥2400 cells/mm²), including age, sex, medical history, cause of death and DRT.
Results:
The study included 611 corneas from 310 donors. The mean ECC was 2624 cells/mm² (SD ±519), with 76.3% (n=466) demonstrating adequate ECC. The mean donor age was 64.4 (SD±15.3) years. The median DRT was 2 hours and 29 minutes. Advanced donor age and pre-existing medical conditions like diabetes mellitus, hypertension, ischemic heart disease, and prior cataract surgery were all identified as risk factors for lower ECC (P<0.001), indicating a negative impact on corneal suitability for transplantation. Multivariate analysis confirmed that age and history of cataract surgery were the only significant risk factors for a reduced ECC (P<0.0001). There was a trend towards a higher chance of adequate ECC in corneas retrieved within 4 hours of death (82.5% vs. 75%; p=0.11), but this association did not reach statistical significance.
Conclusions:
Our findings indicate that advanced donor age, prior cataract surgery, death due to sepsis, and underlying medical conditions such as diabetes mellitus, hypertension, and ischemic heart disease significantly reduce corneal ECC, thereby negatively affecting the suitability of corneas for transplantation. Furthermore, we suggest a potential benefit of shorter DRT on corneal suitability, warranting further investigation.
Introducing a Novel Approach Using 3D Technology to Create Personalized Molds for AntibioticLoaded Articulating Spacers in Orthopedic Shoulder Surgeries
Asaf Bloch BMSc, Or Benifla B.Des, Dan Prat MD MBA, Alon Friedlander MD, Guy Vogel MD, Erel Ben Ari MD, Dina Orkin MD and Amit Zabtani MD
13-18
Background:
Antibiotic-loaded spacers serve as a common intervention for challenging joint infections. Articulating spacers offer joint congruency, contracture prevention, and functional restoration. Technological advancements in clinical data annotation have facilitated the development of 3D printed anatomically accurate models, serving as templates for molds to craft patient-specific antibiotic-loaded medical cement spacers.
Objectives:
This study aims to evaluate the effectiveness of using 3D printing technology for creating patient-specific, antibiotic-loaded articulating spacers in managing orthopedic shoulder infections. It seeks to determine the potential of this novel approach to improve clinical outcomes and reduce infection recurrence compared to traditional treatment methods.
Methods:
Eleven patients underwent treatment with personalized antibiotic-impregnated cement spacers over a 2-year period at Chaim Sheba Medical Center, Tel-Hashomer. The study aimed to assess the efficacy of this novel approach in eradicating infections and enhancing patient outcomes.
Results:
Eradication of infection was successfully achieved in 91% of cases, demonstrating the effectiveness of individualized antibiotic-impregnated cement spacers. Patient satisfaction and minimal pain until the second stage of surgery were universally reported, reflecting positive outcomes.
Conclusions:
This study introduces a promising paradigm in the treatment of complex joint infections, utilizing 3D-printed patient-specific antibiotic-impregnated spacers. The high success rate, coupled with positive patient experiences, suggests the potential superiority of this approach over traditional methods. This innovation marks a significant step towards personalized treatments for infected nonunion and prosthetic joint infections, emphasizing the transformative role of patient-specific 3D-printed spacers in orthopedic care.
The etiology ,prevalence and characteristics of nystagmus in children under the age of one in Israeli populations
Emanuel Goldman-Shaubi BSc, Karen Hendler MD1,2 and Claudia Yahalom MD
19-24
Background:
Nystagmus in childhood can appear either during infancy or later as acquired nystagmus. Studies have reported a prevalence of up to 6.1 cases per 10,000 children. The causes of nystagmus in infancy are diverse and include ocular, neurological, and idiopathic factors.
Objectives:
To study the main causes for nystagmus in infants aged 0-1 year and to evaluate the accompanying clinical characteristics and the different diagnostic tests used for reaching a definitive diagnosis.
Methods:
A retrospective study was conducted on medical records of infants up to one year old who were seen at the Hadassah Medical Center between 2016 and 2021. Clinical data were obtained including age at presentation, presence of strabismus, refractive errors, auxiliary test performed to reach diagnosis and final diagnosis.
Results:
147 infants were included in the study. The most common ocular pathology causing nystagmus was albinism followed by inherited retinal dystrophies (IRD). The main tests used to reach diagnosis included clinical examination, genetic testing and electroretinogram (ERG). MRI was performed in 29/147 (20%) of cases; a diagnosis of a neurologic cause for nystagmus was found in 6/29 infants. Vertical nystagmus was seen in 8/147 infants; among them four had an IRD as a final diagnosis. The most common associated clinical characteristics were high astigmatism and strabismus.
Conclusions:
The most common causes for nystagmus during the first year of life are albinism and retinal dystrophies. The main tools to reach diagnosis were clinical ophthalmologic examination for albinism and electrophysiology together with genetic testing for IRD. Nystagmus secondary to a neurologic condition is rare in this age group. Vertical nystagmus is uncommon and is often associated with IRD and other ocular pathology.
Uric Acid as a Prognostic Marker for Pulmonary Hypertension in ILD Patients Waiting for Lung Transplants
Alon Gorenshtein and Shimon Izhakian MD PhD
25-31
Background:
Uric acid (UA) has been extensively studied as a biomarker for the prediction of pulmonary arterial hypertension (World Health Organization Group 1), in particular idiopathic pulmonary hypertension and connective tissue disease-pulmonary arterial hypertension without interstitial lung disease (ILD). However, there is a lack of studies regarding pulmonary hypertension (PH) due to interstitial lung disease (PH-ILD).
Objectives:
Given that the primary screening tool, transthoracic echocardiogram, has limitations including lower accuracy than the gold standard right heart catheterization, there is a need for additional screening methods. Therefore, finding an association between UA and PH-ILD will help clinicians with the screening process.
Methods:
UA levels were evaluated in 278 patients with endstage ILD who are candidates for lung transplantation at Rabin Medical Center, the national center for lung transplantation in Israel since 1997. Associations between marker levels and mortality were assessed using Cox regression models, adjusting for potential influencing variables.
Results:
UA values correlated positively with c-reactive protein, body mass index, forced vital capacity, cardiac output, mean pulmonary arterial pressure, and pulmonary capillary wedge pressure while having a negative correlation with cardiac index. In univariate analysis, higher UA (OR 1.207 95% CI 1.004-1.45, p=0.044), pulmonary capillary wedge pressure (OR 1.26, 95% CI 1.16-1.36, p<.0001), and pulmonary vascular resistance (OR 2.086 95% CI 1.6-2.71, p<.0001) were significantly correlated with PH-ILD. In linear regression analysis, elevated UA (β = 1.5281, p <0.001) was the variable significantly associated with PH.
Conclusions:
This study indicates that UA can serve as a predictor for PH-ILD in lung-transplanted candidates with ILD. However, additional studies are essential to substantiate our findings.
Conversion of Sleeve Gastrectomy to Roux-Y Laparoscopic Gastric Bypass: A Comprehensive-4 Year Follow-Up Study of Efficacy ,Safety and Outcomes
Yulia Petriuk BSc, Shlomi Rayman MD, Reut El-On MD, Danit Dayan, Shai Eldar MD, Adam Abu Abeid MD, Andrei Keidar MD
32-39
Background:
Failed sleeve gastrectomy (SG), defined by inadequate weight loss or weight regain and by reflux and structural complications, can be treated by a laparoscopic conversion to Roux-Y gastric bypass (RYGB).
Objectives:
Examine the efficacy, safety, and outcomes of conversion surgery over a 14 year follow-up period.
Methods:
Cohort study of 58 patients who underwent conversion of SG to RYGB during 2009-2023. Weight dynamics analysis calculated with two references of weight: pre-SG (by intention to treat) and pre-conversion.
Results:
At conversion surgery, the mean weight, BMI, percentage of excess weight loss (%EWL) and percentage of total weight loss (%TWL) (calculated for intention to treat, from the weight pre-SG) were 92.2±25.2kg, 34.3±8.0kg/m2, 55.2±39.9% and 22.8±15.2% respectively. Mean nadir weight, BMI, percentage of excess weight loss (%EWL) and percentage of total weight loss (%TWL) after conversion (calculated from the weight pre-SG) were respectively 71.1±18.4kg, 26.7±5.5kg/m2, 96.5±30.5%, and 40.2±10.6%. At follow-up, the mean weight, BMI, %EWL and %TWL (calculated from the weight pre-SG) were respectively 80.4±17.7kg, 29.6±5.4kg/m2, 78.9±26.8% and 33.3±11.2%. The mean percentages of %EWLio and %TWLio (calculated from the weight pre-conversion = EWL from index operation) at nadir were respectively 73.2±92.7%, 20.1±12.2% post-conversion and decreased to 41.9±94.0% and 13.2±15.2% respectively at last follow-up (mean 6.6 years).
Conclusions:
SG to RYGB conversion provides moderate to low complementary weight loss in the short term. By 3-4 years, there is a clear trend toward weight gain. Additionally, reflux resolution is favorable but not universal.
Quality of Life in Children With Albinism: The Influence of Visual Impairment and the Role of Rehabilitation
Benyamin. A. Rozen BSc, Devora Mirsky, M Optom, Karen Hendler MD, Irit Rozen-Knisbacher MD, Claudia Yahalom MD
40-45
Background:
Vision impairment in albinism has the greatest impact on quality of life (QoL) for affected individuals due to
lack of melanin production, leading to reduced visual acuity, photophobia, nystagmus, strabismus and other issues. This study aims to evaluate the QoL and overall well-being of children with albinism compared to children with normal vision using the VFQ-25 questionnaire.
Objectives:
To evaluate and contrast the QoL of children with albinism and those with normal vision using the "National Eye Institute Visual Function Questionnaire" abbreviated version NEI-VFQ-25; and to investigate the impact of visual rehabilitation interventions on QoL.
Methods:
Prospective study employing the NEI-VFQ-25 to assess symptoms, daily life activities, emotional health and social function in children with albinism. A control group with normal visual acuity was used for comparison. Basic statistical analysis of processed results derived from the NEI-VFQ-25 was conducted with help of the institutional statistical coordinator.
Results:
Out of 73 participants, 43 children had albinism and 30 were healthy controls; those with albinism had lower QoL. Significant correlations between lower visual acuity and reduced QoL were found, especially pronounced when photophobia was present. Subgroup analyses within albinism genotypes indicated statistically significant variations in visual quality. The role of rehabilitation factors was explored, associating a greater need for a specialized teacher's help at school with lower QoL.
Conclusions:
Our study offers a comprehensive evaluation of QoL in children with albinism, underscoring the significant correlation between visual acuity deficits and reduced QoL scores. Photophobia notably affects QoL more than visual acuity alone, emphasizing the need to address this specifically in management strategies. While specialized classroom assistance was related to QoL, its impact should be cautiously interpreted. These findings underline the need for personalized care that fully considers albinism's effect on children's lives.
Prognostic Value of Hyponatremia for Predicting Poor Outcome in COVID-9 patients
Shai Stern, Raymond Farah MD
46-52
Background:
Low levels of sodium in the blood, or hyponatremia, have been repeatedly linked to adverse outcomes in several diseases. Hyponatremia in patients with COVID-19 may have a variety of pathophysiological causes, with the most common being syndrome of inappropriate antidiuretic hormone secretion (SIADH), followed by adrenal insufficiency, gastrointestinal sodium ion loss, decreased sodium ion intake, and the use of diuretic therapy. This study delves into the complex relationship between hyponatremia and disease severity in COVID-19 patients. We investigated the relationship between hyponatremia and the duration of hospitalization and examines its potential as a risk stratification tool for high-risk patients. Using observational and retrospective methodology, we rigorously analyzed medical records from COVID-19 patients in an internal medicine department. Medical records included key data: demographics, medical history, laboratory findings, treatments, and outcomes.
Objectives:
Our goal in conducting this study was to better understand how hyponatremia affects the prediction of outcome in COVID-19 patients so that we can make wise clinical management decisions in hyponatremic COVID-19 patients.
Methods:
The study population was patients who contracted COVID-19 between the years 2020-2023 and were hospitalized at the Ziv Medical Center. The disease was diagnosed by the PCR method from the nasopharyngeal region. Clinical and demographic data were collected from the medical files of these patients and approved by the Ziv Medical Center’s Institutional Review Board (0045-23-ZIV).
Results:
We identified 295 COVID-19 patients. We found that hyponatremic COVID-19 patients had more severe disease, lower oxygen saturation levels, and longer hospital stays compared to non-hyponatremic COVID-19 patients.
Conclusions:
Hyponatremia on admission can be used to forecast the length of hospital stay and the severity of illness in COVID-19 patients. Hyponatremia is found to be more prevalent in older patients. Correcting the serum sodium imbalance at an early stage can help reduce complications and duration of hospitalization for patients.
Review Articles
Anosmia – A Neurological Complication of COVID-19
Dmitry Markovich MD
53-59
Background:
SARS-CoV-2, a new strain of coronavirus, emerged in 2019 and led to a global pandemic of the respiratory infectious disease COVID-19. SARS-CoV-2 is a coronavirus with positive-sense, single-stranded RNA that belongs to the order Nidovirales. It is not the first coronavirus to draw global attention. Its predecessors SARS-CoV and MERS-CoV respectively caused an epidemic in China in November 2002 and in Saudi
Arabia in April 2012. SARS-CoV-2 has some unique features including rapid transmission and a wide range of respiratory and neurological symptoms. Anosmia, commonly accompanied by dysgeusia, emerged as one of the most common neurological symptoms, sometimes even presenting as the only symptom
and significantly impacting the quality of patients’ lives.
Objectives:
This review aims to discuss the possible pathogenesis, symptomatology, and treatment of anosmia in COVID-19.
Methods:
A systemic literature review of the latest published articles was conducted using the platforms PubMed and Google Scholar, focusing on olfactory and taste dysfunction induced by SARS-CoV-2. Possible pathophysiologic mechanisms, symptomatology, and treatment were analyzed and summarized.
Results:
The most supported theory for the pathogenesis of anosmia is viral infection and damage of sustentacular supporting cells and/or inflammatory damage to olfactory mucosa. This leads to disturbed odorant processing and signal transmission. Additionally, a comparison of anosmia in other respiratory viruses like influenza, revealed no common pathophysiology with COVID-19-induced anosmia. Although SARS-CoV-2 was found in the CNS, the route of spread and contamination is still being studied and possible ways that have been suggested are hematogenous spread and direct spread through cribriform plate and olfactory pathways. Most patients recover within two weeks. In cases of prolonged anosmia, therapy options include smell training, corticosteroids, and psychological support.
Conclusions:
COVID-19-induced anosmia is likely a result of unique damage to supporting olfactory cells and local inflammation. While most patients recover fully within two weeks, there is a need for more research to elucidate why patients experience prolonged anosmia and how to treat this.
Letters To The Editor
"We too are humans": A message from Israeli Medical Students
Garrick Hoichman BMSc, Miri Shvimmer BSN, MSc
60
Background:
Objectives:
Methods:
Results:
Conclusions:
Commentary
Takayasu Arteritis and Coronary Artery Occlusion
Vitorino Modesto dos Santos MD PhD, Taciana Arruda Modesto Sugai MD and Lister Arruda Modesto dos Santos MD
61-62
Background:
This Journal recently published an interesting case study about a rare coronary artery obstruction caused by Takayasu arteritis in a 23-year-old woman who presented with episodes of short duration of retrosternal pain, dyspnea and sweating, and the initial reviewed electrocardiogram revealed abnormalities indicative of myocardial infarction. During her hospitalization, the imaging studies showed a critical narrowing of the left main coronary artery, besides the ascending aorta dilation and the suspicion of vasculitis. She underwent an angioplasty with stent insertion and solumedrol pulse therapy, prednisone, aspirin, and clopidogrel; and routine laboratory evaluation for vasculitis. The authors concluded that Takayasu arteritis was the most consistent diagnostic option. During her four years of careful follow-up, there were annual catheterizations allowing to diagnose new obstructions (up to 90%) in the right coronary and circumflex arteries, which were treated with the immunosuppressant tocilizumabe in addition to prednisone. She remains asymptomatic, without coronary occlusions in the catheterizations of control. Aiming to highlight the main issues, additional literature comments are herein presented.
Objectives:
Methods:
Results:
Conclusions:
Epiphany
What is art but a way of seeing?
@hayon.ink
64
Background:
Objectives:
Methods:
Results:
Conclusions: