October 7th 2023 mass casualty incident in southern Israel: lessons for emergency preparedness and management.

Background: Mass Casualty Incidents (MCIs) pose significant challenges for healthcare systems. While policies are typically crafted based on past experiences, the lessons learned from each incident play a crucial role in enhancing emergency preparedness. On October 7th, 2023, Israel came under the largest terror attack in its history.

Left gastric artery embolization for recurrent massive intraluminal postoperative bleeding after revisional laparoscopic one anastomosis gastric bypass surgery.

Laparoscopic one-anastomosis gastric bypass (LOAGB) has gained popularity as safe weight-reduction procedure. Bleeding is the common postoperative complication. We present a successful treatment of recurrent bleeding after LOAGB by embolization of the left gastric artery (LGA) and later development of necrotizing pancreatitis.

Banded One-Anastomosis Gastric Bypass (BOAGB) for Patients Living with Obesity and Extreme Obesity: A Single Institution's Experience.

Background: The prevalence of patients suffering from extreme obesity (body mass index (BMI) ≥ 50) has significantly increased over the past three decades, surpassing the rise in the general population of overweight patients. Weight loss outcomes after bariatric surgery in patients suffering from extreme obesity are less favorable, with a higher incidence of weight regain. Variations of existing bariatric procedures have been proposed to address this issue.

Clinical characteristics of SARS-CoV-2 vaccine-related acute appendicitis.

Background: In a large nationwide mass vaccination setting, the SARS-CoV-2 vaccine was recently linked to myocarditis, lymphadenopathy, herpes zoster infection and appendicitis. We aimed to examine the characteristics and management of SARS-CoV-2 vaccine-related acute appendicitis.

Methods: We performed a retrospective cohort study in a large tertiary medical centre in Israel.

An Unusual Presentation of HCC in a Patient with No Underlying Liver Disease: A Case Study.

Pedunculated hepatocellular carcinoma (P-HCC) is a rare subtype of HCC. P-HCC may occur in patients without underlying liver cirrhosis and can be present with negative serum tumor markers. With a growing worldwide incidence of nonalcoholic fatty liver disease, non-cirrhotic HCC will likely become more prevalent.

The Israeli Surgical Oral Board Examination: Improved Objectivity Increases Knowledge Authenticity.

The oral board examination in general surgery in Israel was recently revised aiming for improved objectivity and standardization. Herein, we describe the current exam model. Between 05/2018 and 11/2020, two exams per year were conducted with the current exam model.

Adapting Surgical Clerkship Curricula in Response to the COVID-19 Pandemic.

Background: Coronavirus disease-19 (COVID-19) impacted medical education and led to the significant modification or suspension of clinical clerkships and rotations.

Objectives: To describe a revised surgery clerkship curriculum, in which we divided in-person clinical teaching into smaller groups of students and adopted online-based learning to foster student and patient safety while upholding program standards.

Methods: The third-year surgery core clerkship of a 4-year international English-language program at the Medical School for International Health at Ben Gurion University of the Negev, Beer Sheva, Israel, was adapted by dividing students into smaller capsules for in-person learning and incorporating online learning tools.

Stomach pH before vs. after different bariatric surgery procedures: Clinical implications for drug delivery.

Stomach pH may vary following bariatric surgery, with implications for drug delivery/bioavailability. Yet, this parameter has not been studied. In this work, gastric content was aspirated from patients before, immediately after, and the day after different bariatric procedures, and pH was immediately measured.

Circulating Cell-free DNA in Patients With Acute Biliary Pancreatitis: Association With Disease Markers and Prolonged Hospitalization Time-A Prospective Cohort Study.

Objective: To evaluate cfDNA as an indicator of pancreatitis severity.

Background: Acute pancreatitis severity scores have limited proficiency, and are complex and challenging to use clinically. Elevation of circulating cfDNA concentration has been shown to be associated with hospital length of stay (LOS) and mortality.

Foramen of Winslow hernia years after a Ladd's procedure: A case report.

Foramen of Winslow hernias form 8% of all internal hernias. They present with non-specific findings and are often diagnosed late in disease progression. Delayed diagnosis of the hernia is associated with an estimated mortality of 50%.

Intra-abdominal pressure may be elevated in patients with open abdomen after emergent laparotomy.

Purpose: To estimate the change in intra-abdominal pressure (IAP) among critically ill patient who were left with open abdomen and temporary abdominal closure after laparotomy, during the first 48 h after admission.

Methods: A cohort study in a single ICU in a tertiary care hospital. All adult patients admitted to the ICU after emergent laparotomy for acute abdomen or trauma, who were left with temporary abdominal closure (TAC), were included.

The effect of steroid treatment on whiplash associated syndrome: a controlled randomized prospective trial.

Purpose: There is significant evidence in the literature that low or relatively low cortisol concentrations near the time of an accident are associated with more severe forms of whiplash-associated disorders. We hypothesized that treating patients that were involved in a motor vehicle accident with hydrocortisone would alleviate the incidence and severity of these disabling disorders.

Methods: A prospective, randomized, double-blind, placebo-controlled clinical trial.

Increased Paracetamol Bioavailability after Sleeve Gastrectomy: A Crossover Pre- vs. Post-Operative Clinical Trial.

Oral drug bioavailability may be significantly altered after laparoscopic sleeve gastrectomy (LSG), the most popular bariatric procedure worldwide. Paracetamol (acetaminophen) is the post-bariatric analgesic/antipyretic drug of choice. In this work we studied and analyzed the LSG effects on systemic bioavailability and pharmacokinetics of paracetamol after oral administration of solid vs.

New results on the safety of laparoscopic sleeve gastrectomy bariatric procedure for type 2 diabetes patients.

Background: It has been established that bariatric surgery, including laparoscopic sleeve gastrectomy (LSG), has a positive impact on type 2 diabetes mellitus (T2DM). However, less frequently T2DM is reported as a risk factor for complications with this type of surgery.

Aim: To evaluate the safety of LSG in T2DM.

Can cortisol levels predict the severity of acute whiplash-associated disorders?

Background: The exact underlying mechanism of whiplash-associated disorders still remains obscure. Central sensitization of the brain to painful stimulus and disturbances in the hypothalamic-pituitary-adrenal axis has been suggested to contribute to the development of whiplash-associated disorders. Although cortisol is a well-known factor in the acute stress response and its effects on chronic pain sensation were studied, information is lacking regarding the relation between acute phase cortisol concentrations and the intensity of whiplash-associated disorders.

The Clinical Outcome of Postoperative Invasive Fungal Infections Complicating Laparoscopic Sleeve Gastrectomy.

Purpose: Peritonitis is a major complication of bariatric surgery due to direct damage to the natural barriers to infection. Most such secondary peritoneal infections are caused by Gram-negative microorganisms; however, under certain conditions, Candida species can infect the peritoneal cavity following bariatric surgery.

Materials And Methods: We retrospectively analyzed the clinical and microbiological data of morbidly obese patients who suffered infectious complications following laparoscopic sleeve gastrectomy (LSG) at the Soroka Medical Center between January 2010 and June 2015.

Modified ISTH pregnancy-specific DIC score in parturients with liver rupture: population-based case series.

Objectives: Liver rupture and hematoma are rare life-threatening complications of pregnancy. The aims of the current study are to: (1) characterize in a population-based study all cases of liver hematoma and/or rupture; and (2) validate the utility of the International Society on Thrombosis and Haemostasis (ISTH) modified pregnancy specific disseminated intravascular coagulation (DIC) score in those cases.

Study Design: A retrospective cohort study including all patients with liver subcapsular hematoma or rupture between the years 1996 and 2012 was conducted.

Invasive Infection after Upper Gastrointestinal Tract Surgery for Gastric Cancer.

Upper gastrointestinal tract (GIT) surgical procedures are more likely to cause nosocomial than lower GIT procedures and they thus constitute an independent risk factor for mortality. Because of the severity of postsurgical fungal infections complications, intensivists and surgeons need to be extremely aware of their clinical importance in critically ill postsurgical intensive care unit (ICU) patients. We analyzed the clinical and microbiological data of 149 oncologic patients who were hospitalized in the ICU at Soroka Medical Center between January 2010 and January 2015 after undergoing upper GIT surgery for gastric cancer.

Cell-free deoxyribonucleic acid as a prognostic marker of bowel ischemia in patients with small bowel obstruction.

Background: Patients with strangulation small bowel obstruction are at a high risk for serious morbidity and mortality due to ischemic bowel. Measuring serum, cell-free deoxyribonucleic acid levels could help recognize early cell death. Our hypothesis was that small bowel ischemia or necrosis is associated with increases in serum cell-free deoxyribonucleic acid and that recovery is associated with a decrease in cell-free deoxyribonucleic acid levels.

The Impact of Technical Surgical Aspects on Morbidity of 984 Patients after Sleeve Gastrectomy for Morbid Obesity.

Background: To evaluate early complications after LSG in regard of staple line reinforcement (SLR), bougie size, previous bariatric surgery and surgeon experience.

Methods: A retrospective cohort study of LSG patients at the Soroka University Medical Center (SUMC). Data was collected from digitalized database.

Oral drug therapy following bariatric surgery: an overview of fundamentals, literature and clinical recommendations.

Bariatric surgery is the most effective solution for severe obesity and obesity with comorbidities, and the number of patients going through bariatric surgery is rapidly and constantly growing. The modified gastrointestinal anatomy of the patient may lead to significant pharmacokinetic alterations in the oral absorption of drugs after the surgery; however, because of insufficient available literature and inadequate awareness of the medical team, bariatric surgery patients may be discharged from the hospital with insufficient instructions regarding their medication therapy. In this article, we aim to present the various mechanisms by which bariatric surgery may influence oral drug absorption, to provide an overview of the currently available literature on the subject, and to draw guidelines for the recommendations bariatric surgery patients should be instructed before leaving the hospital.