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Objective Methods Results Conclusions To identify the key risk factors contributing to re‐hospitalization after term cesarean delivery (CD).This retrospective cohort study included women who underwent CD at term at a university‐affiliated tertiary medical center (January 2021 to March 2023). The primary outcome was risk factors for re‐hospitalization within 30 days post‐discharge. Data on selected maternal demographic, pregnancy‐related and delivery variables were extracted from electronic medical records. A multivariable logistic regression analysis was conducted to identify independent risk factors for re‐hospitalization. Logistic regression analysis was used to determine the odds ratios (ORs) and 95% confidence intervals (CIs) for various independent risk factors.A total of 2878 women were included in the study, of whom 76 required re‐hospitalization (2.6%). The rates of high‐risk pregnancies were more prevalent among those who were re‐hospitalized (41 [62.1%] vs. 1148 [49.1%], P = 0.043). Furthermore, the rates of emergency CDs (42 [56%] vs. 1040 [37.8%], P = 0.001), prolonged surgery duration (17 [22.4%] vs. 292 [10.4%], P = 0.001) and hospitalization duration (14 (18.4%) vs. 273 (9.7%), P = 0.015) were significantly higher in the re‐hospitalized group. Emergency CD (OR 1.90, 95% CI 1.06–3.42, P = 0.030) and prolonged surgery duration (OR 2.44, 95% CI 1.25–4.77, P = 0.016) remained significant risk factors of re‐hospitalization in the multivariate analysis.The need for emergency CD and prolonged surgery duration were found as independent risk factors for re‐hospitalization after CD at term. [ABSTRACT FROM AUTHOR]

ABSTRACT INTRODUCTIONLactate levels are increasingly used to risk stratify emergency department (ED) patients with and without infection. Whether a serum lactate provides similar prognostic value across diseases is not fully elucidated. This study assesses the prognostic value of serum lactate in ED patients with and without infection to both report and compare relative predictive value across etiologies.METHODSWe conducted a prospective, observational study of ED patients displaying abnormal vital signs (AVS) (heart rate ≥130 bpm, respiratory rate ≥24 bpm, shock index ≥1, and/or systolic blood pressure 4.0mmol/L. Trended stratified lactate levels were associated with deterioration for both infected (p 4mmol/L was an independent predictor of deterioration for patients with infection (OR 4.8, 95% CI: 1.7 – 14.1) and without infection (OR 4.4, 1.7 – 11.5).CONCLUTIONLactate levels can risk stratify patients with AVS who have increased risk of adverse outcomes regardless of infection status.

α1-Antitrypsin (AAT), an acute-phase reactant not unsimilar to C-reactive protein (CRP), is a serine protease inhibitor that harbors tissue-protective and immunomodulatory attributes. Its concentrations appropriately increase during conditions of extensive tissue injury, and it induces immune tolerance, in part, by inhibiting the enzymatic activity of the inflammatory serine protease, proteinase 3 (PR3). Typically administered to patients with genetic AAT deficiency, AAT treatment was recently shown to improve outcomes in patients with steroid-refractory graft-versus-host disease (GVHD). GVHD represents a grave outcome of allogeneic hematopoietic stem cell transplantation (HSCT), a potentially curative intervention for hematological diseases. The procedure requires radio/chemotherapy conditioning of the prospective marrow recipient, a cytotoxic process that causes vast tissue injury and, in some formats, interferes with liver production of AAT. To date, changes in the functional profile of AAT during allogeneic HSCT, and during the cytotoxic intervention that precedes HSCT, are unknown. The present study followed 53 patients scheduled for allogeneic HSCT (trial registration NCT03188601). Serum samples were tested before and after HSCT for AAT and CRP levels and for intrinsic anti-proteolytic activity. The ex vivo response to clinical-grade AAT was tested on circulating patient leukocytes and on a human epithelial cell line treated with patient sera in a gap closure assay. According to the ex vivo experiments, circulating leukocytes responded to AAT with a favorable immune-regulated profile, and epithelial gap closure was enhanced by AAT in sera from GVHD-free patients but not in sera from patients who developed GVHD. According to serum collected prior to HSCT, non-relapse mortality was reliably predicted by combining three components: AAT and CRP levels and serum anti-proteolytic activity. Taken together, HSCT outcomes are significantly affected by the anti-proteolytic function of circulating AAT, supporting early AAT augmentation therapy for allogeneic HSCT patients. [ABSTRACT FROM AUTHOR]

While commonly thought to be effective for management of limb and junctional hemorrhage, the manual pressure points technique was excluded from leading prehospital guidelines over a decade ago following the publication of a single human-volunteers study presenting unfavorable results. This work aimed to re-assess the efficacy and feasibility of the femoral and supraclavicular pressure points technique for temporary hemorrhage control distal to the pressure point. A prospective, non-randomized, human volunteer, controlled environment study. In the study 35 healthy male combat medics (age 21.1 ± 1.3 years) received brief training after which they were requested to apply pressure in the femoral and supraclavicular points in attempts to stop regional blood flow, measured distally by Doppler ultrasound. Success rates in achieving flow cessation in under 2 minutes, time required for achievement of flow cessation, and cumulative flow cessation duration within a 3-minute follow-up after initial success were measured. For the supraclavicular point, success rates were 97.1% with a mean time to success of 12.5 (±20.9) seconds, lasting for 76.2% (±23.7) of the follow-up time. For the femoral point, success rates were 100% with a mean time to success of 5.5 (±4.3) seconds, lasting for 98.7% (±3.8) of the follow-up time. Manual pressure on the femoral and supraclavicular points is an applicable and efficient method for temporary hemorrhage control distal to the pressure point. As such, with additional study, this method may be considered for re-introduction to prehospital care guidelines and training programs. [ABSTRACT FROM AUTHOR]

Background: Imperforated hymen is a rare condition usually diagnosed at puberty due to amenorrhea accompanied by cyclic pelvic pain and sometimes other significant complications such as hematometra, endometriosis, and infertility. The accepted surgical treatment for imperforate hymen and some other hymenal malformation is hymenectomy. However, given low incidence rates, long-term obstetrical and gynecological outcomes in post-hymenectomy women remain poorly understood.Objective: To investigate long-term obstetrical and gynecological outcomes in nulliparous women who underwent a hymenectomy.Study design: Retrospective study comparing gynecological and perinatal outcomes of nulliparous women with and without hymenectomy, who delivered between the years 1988 and 2015 at the Soroka University Medical Center. Univariate analysis was performed as accepted with multivariate logistic regression model used to assess long-term effects of hymenectomy.Results: During the study period, 56 of 74,598 nulliparous women who delivered at the Soroka University Medical Center had previously undergone a hymenectomy. In a univariate analysis, cesarean deliveries were significantly more prevalent among women who had undergone a hymenectomy (30.4 versus 17.6% p = .01) as were infertility treatments (10.7 versus 4.4% p = .04) and dyspareunia (42.9 versus 0.2% p <.001). In a multivariate logistic regression model hymenectomy was found to be an independent risk factor for significant obstetrical and gynecological outcomes defined as one or more of the following: caesarean deliveries, cervical laceration, vaginal laceration, perineal laceration, preterm delivery, cervical incompetence, endometriosis, infertility, and dyspareunia (OR 2.5, 95% CI 1.26-4.93; p = .001).Conclusions: Hymenectomy is associated with significant long-term obstetrical and gynecological complications. Informing medical teams of these risks might promote early detection and minimize associated complications such as laceration-associated blood loss and preterm delivery. [ABSTRACT FROM AUTHOR]

While many military positions are characterized by rigorous routines and long-hour shifts, some positions also require the practice of sensitivity and empathy alongside diligence and attention. Prolonged exposure to such conditions may promote emotional exhaustion, depersonalization and diminished self-accomplishment perception, all part of work-related burnout which may affect soldiers' ability to practice their duty. The service in the Israel Defense Forces (IDF) checkpoint unit is an example of such conditions due to the soldiers' constant interaction with civilian population. In this questionnaire-based cross-sectional study which included 404 responders from the IDF checkpoint battalions, we examined the effects of demographical, situational and personal variables on soldiers' burnout. A hierarchical multivariate linear regression (R 2 = 0.47) identified sense of coherence, the core concept in the salutogenic model of health, as the most prominent protective factor, followed by service motivation and perceived well-being (WB). Taken together, the results revealed several factors associated with military work-related burnout. These findings can serve as a base for burnout prevention programs, which may potentially improve not only the soldiers' WB but also the interfaces between military and civilian populations. [ABSTRACT FROM AUTHOR]

Objectives: For patients with early stage colorectal cancer (CRC), markers of high-risk relapse are needed. In a previous study on 38 randomly selected patients with CRC, we found good correlation between presurgery cell-free DNA (CFD) concentrations and standard prognostic factors. In the current study, we revisited the same patients at 5-year survival, aiming to evaluate the predictive power of presurgery CFD levels.Methods: We revisited 38 patients with CRC previously analyzed for 5-year outcome. CFD was measured using a simple fluorescent assay that we developed.Results: All recurrent patients and patients who had died of cancer within 5 years were shown to have presurgery CFD values above 800 ng/mL. The negative predictive value for cancer-related disease was 100%. Cox regression analysis for disease-free survival showed a hazard ratio of 6.03 (P = .003) for CFD, which was higher than the ratio of the disease stage, 1.9 (P = .006). The survival-free curve of stage I and II patients with elevated CFD was significantly different from patients with normal levels (P = .0136); 5 (41.7%) of 12 patients had died of cancer or had experienced a recurrence.Conclusions: CFD may possibly be a decisive criterion to identify patients with local disease who might benefit from adjuvant chemotherapy. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to examine the association between voice experience and levels of depression, anxiety, and stage of gender affirmation in transgender women., Study Design: A cross-sectional study., Methods: Adult transgender women attending a tertiary referral center were recruited between April 2022 and January 2023. They filled in a demographic and health survey, the Hebrew Trans Woman Voice Questionnaire (H-TWVQ), the Hebrew Patient Health Questionnaire, and the Hebrew version of the Generalized Anxiety Disorder Screener. Descriptive statistics and data regarding the associations between voice experience, grades of anxiety and depression, and stage of gender affirmation were compiled., Results: Sixty-seven transgender women were included (mean age 26.7 ± 7.78 years, mean time of presenting socially as a woman 5.2 ± 5.2 years). The median H-TWVQ score was 71 (maximal score 120). Most participants reported mild anxiety and mild depression levels. Those who reported a more positive voice experience (H-TWVQ score ≤71) had lower median depression and anxiety scores than participants with a less-positive voice experience (H-TWVQ score >71) (P = 0.028 vs P = 0.044, respectively), complained less of hoarseness (2.9% vs 19.4%, P = 0.045,) and more were employed (78.8% vs 41.9%, P = 0.003). No association was found between voice experience and cross-sex hormone treatment, affirmation surgery undertaken, or number of years presenting socially as a woman., Conclusions: We observed a potential association between better voice experience and lower anxiety and depression levels among transgender women. No association was found between voice experience and the stage of gender affirmation. Physicians treating this population should be aware of these associations and consider therapeutic means for voice adjustment., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Aims: To describe and identify clinical characteristics, prognostic factors and visual outcome in patients with intraocular foreign bodies (IOFB) in southern Israel., Methods: We conducted a retrospective review of all cases of open globe injury with IOFB treated and followed-up for at least 6 months in the Ophthalmology Department at Soroka University Medical Center, Beer Sheva, Israel, from 1995-2011. The study population was subdivided into two groups: 1. Patients whose difference in visual acuity (VA) between presentation and end of follow-up was considered "successful" (n = 54); 2. Patients whose difference in VA between presentation and end of follow-up was considered "non-successful"(n = 14). Comparing these two groups, we analyzed the following: time from trauma to admission, time from admission to operation, location of IOB, wound zone, best corrected VA at admission., Results: A total of 97.1% of the study group were males and the mean age was 28.7 ± 15.3 years. Metallic IOB were found in 73.5% of cases. The IOFB penetrated at Zone 1 in 61.8% cases, and were located at the posterior segment in 65.2 % of cases. The two subgroups differed in their best corrected VA (by LogMAR) at presentation (p value = 0.02): the patients who were defined as "successful" (n = 54) had.a higher mean VA (1.2 ± 1.3) than those (n = 14) who were defined as "non-successful" (1.1 ± 0.6). The duration of time from trauma to admission was not found to be of statistical significance (p value = 0.361, and neither did the time from admission to operation (P value = 1)., Conclusion: We present an innovative definition of VA changes during the follow-up period in patients with open globe injuries involving IOFB. Our study showed that patients who presented with worse VA had a better chance of a "successful" outcome.

Background: Body immersion in plain water or mineral water induces significant and unique physiological changes in most body systems. In a previous pilot study, a significant reduction in blood glucose levels among diabetes mellitus (DM) patients was found following a single immersion in Dead Sea water but not after immersion in plain water., Objective: To study the immediate and long term effects of immersion in mineral water for five consecutive days on blood glucose in patients with type 2 DM., Methods: A total of 34 patients with type 2 DM were divided into 2 groups: The first immersed in a plain water pool and the second immersed in a Dead Sea water pool; both pools were warmed to a temperature of 35°C. Immersions for 20 minutes occurred twice daily: two hours after breakfast and before dinner. Seven samples of capillary blood glucose levels were taken: fasting, before and after every immersion, prior to lunch and before bedtime. Hemoglobin A1C (HbA1c) was taken prior to the study and a re-check was conducted during the 12 weeks following the study., Results: Blood glucose levels significantly decreased immediately after immersion both in Dead Sea water and plain water compared to their values prior to immersion (p<0.001). No significant difference was noted between both types of water. A decrease in fasting glucose levels was observed only in the group immersed in Dead Sea water when compared to plain water (6.83±5.68 mg/dl versus 4.37±1.79 respectively and the difference was close to statistical significance (p=0.071. There were no changes in HbA1c levels., Conclusion: Immersion for 20 minutes in water (Dead Sea or plain water) at a temperature of 35°C induced an immediate reduction in glucose levels in patients with type 2 DM.