Clinical Outcomes of Patients with AmpC-Beta-Lactamase-Producing Enterobacterales Bacteremia Treated with Carbapenems versus Non-Carbapenem Regimens: A Single-Center Study.

Introduction: Bloodstream infections caused by AmpC-producing Enterobacterales pose treatment challenges due to the risk of AmpC overproduction and treatment failure. Current guidelines recommend carbapenems or cefepime as optimal therapy. We aimed to evaluate empiric and definitive non-carbapenem regimens for these infections.

Process of drug registration in Israel: the correlation between the number of discussions within the Ministry of Health and postapproval variations by EMA and/or FDA.

Objectives: US FDA and EMA allow facilitated regulatory pathways to expedite access to new treatments. Limited supportive data may result in major postapproval variations. In Israel, partly relying on Food and Drug Administration (FDA) and European Medicines Agency (EMA), clinical data are reviewed independently by the Advisory Committee of Drug Registration (ACDR).

[CASE REPORT: LEGAL, PSYCHOLOGICAL AND ETHICAL ASPECTS OF THE DYING PATIENT ACT].

We present a patient with amyotrophic lateral sclerosis (ALS), dependent on noninvasive ventilation, whose advance directives precluded life-prolonging measures. The patient was found in cardiac arrest and in accordance with the directives of her surrogate decision maker, underwent intubation and mechanical ventilation. Later, an additional surrogate decision maker disapproved of ventilation and when the ventilator was disconnected for bronchial suctioning, she asked the nurse not to reconnect the patient to the ventilator.

Reducing blood culture contamination using an initial specimen diversion device.

Objectives: False positive blood cultures result from contamination, consuming laboratory resources and causing unnecessary antibiotic treatment and prolonged hospital stay. Skin disinfection reduces contamination; however, bacteria colonizing human skin are also found in tissues deep into the skin surface. A diversion device diverts the initial 1-2 mL of blood to remove any potentially contaminated skin plug.

[MONITORING UNITS IN DEPARTMENTS OF INTERNAL MEDICINE: FREQUENCY, IMPACT AND SATISFACTION].

Background: Due to increasing numbers of elderly, seriously ill patients and shortage of ICU beds, many hospitals have established monitoring units (MU) in their medical departments.

Objectives: (1) To assess the national prevalence of MUs in medical departments; (2) to determine the outcome of consecutively admitted MU patients; (3) to evaluate patient/ family satisfaction with care.

Methods: The case control study included all 123 patients hospitalized in the MU during a 5-month period, compared with two control groups: (1) 123 patients admitted to medical departments, matched at a ratio of 1:1 by gender, age±10 years and mechanical ventilation; (2) all 52 medical patients treated in the ICU.

Nicotine Addiction and Withdrawal among Orthodox Jews: the Effect of Sabbath Abstinence.

Background: Cigarette smoking is a widespread problem around the world. In Israel, the prevalence of smoking is 23%. Smokers who are Orthodox abstain from smoking during the Sabbath, i.

Operating a Monitoring Unit in the Geriatric Department: Effects on Outcomes.

Objectives: To compare the effect of a five-bed geriatric monitoring unit (MU) on in-hospital mortality and length of stay with the effect of usual care in a geriatric hospital department and a medical MU.

Design: Prospective, case-control, noninterventional study.

Participants: All individuals hospitalized for 24 hours or longer in the geriatric MU (n = 89, aged 53-101, mean age 82.

Anti-Factor Xa Activity of Prophylactic Enoxaparin Regimens in Critically Ill Patients.

Background: Enoxaparin is frequently used as prophylaxis for deep venous thrombosis in critically ill patients.

Objectives: To evaluate three enoxaparin prophylactic regimens in critical care patients with and without administration of a vasopressor.

Methods: Patients admitted to intensive care units (general and post-cardiothoracic surgery) without renal failure received, once daily, a subcutaneous fixed dose of 40 mg enoxaparin, a subcutaneous dose of 0.

Prokinetic drugs for gastric emptying in critically ill ventilated patients: Analysis through breath testing.

Purpose: The prupose was to identify, through the BreathID automatic breath-testing device, the best prokinetic therapy to enhance gastric-emptying rate (GER) in ventilated intensive care unit patients.

Materials And Methods: This was a prospective, crossover, nonrandomized study. Consecutive ventilated patients who could be fed enterally and expected to require 5 days of ventilation were included.

Prosthetic valve endocarditis due to Streptococcus pneumoniae.

Introduction: In the pre-antibiotic era up 10% of cases of infective endocarditis were due to Streptococcus pneumoniae, but this association is currently exceedingly rare.

Case Description: Since 1997 we have diagnosed three patients, all aged >70, with endocarditis due to S. pneumoniae.

[Shaare Zedek Medical Center's model of an integrated division of internal medicine].

Background: The specialty and practice of internal medicine have been subject to serious challenges in the last two decades.

Methods: We describe the integrative model of internal medicine as developed in our hospital, providing solutions to some major challenges.

Results: Major components include: (1) Senior physicians and residents are employed by the Division rather than individual Departments of Medicine, allowing for balanced distribution of professional capabilities.

[Impact of a monitoring unit in the medical department on patient outcome].

Purpose: Many hospitals have established monitoring units (MU) in their medical departments, with operating costs that are significantly lower than Intensive Care Units, but with no data on their effectiveness. We determined the outcome of patients, who were treated in a new MU during their hospitalization, compared with that of a control group.

Methods: We included all patients, who were admitted to the MU during a five months period.

Use of non-vitamin, non-mineral (NVNM) supplements by hospitalized internal medicine patients and doctor-patient communication.

Objective: To study non-vitamin, non-mineral (NVNM) supplements use and disclosure of among hospitalized internal medicine patients.

Methods: A convenience sample of patients completed an interviewer-administered questionnaire examining use of and perceptions regarding NVNM supplements, and disclosure to medical personnel.

Results: 280 patients were interviewed (54% female), 15.

A safety trial of high dose glyceryl triacetate for Canavan disease.

Canavan disease (CD MIM#271900) is a rare autosomal recessive neurodegenerative disorder presenting in early infancy. The course of the disease is variable, but it is always fatal. CD is caused by mutations in the ASPA gene, which codes for the enzyme aspartoacylase (ASPA), which breaks down N-acetylaspartate (NAA) to acetate and aspartic acid.

Relationship between CYP2A6 genetic polymorphism, as a marker of nicotine metabolism, and ulcerative colitis.

Background: Ulcerative colitis (UC) is a common and difficult-to-treat disease. In non-smokers the relative risk of developing UC is 2.9 compared with smokers, who tend to have a later onset and a milder disease.

Nicotiana glauca (tree tobacco) intoxication--two cases in one family.

We present two cases of rare human poisoning in one family following ingestion of cooked leaves from the tobacco tree plant, Nicotiana glauca. The toxic principle of N. glauca, anabasine (C10H14N2), is a small pyridine alkaloid, similar in both structure and effects to nicotine, but appears to be more potent in humans.

Enoxaparin dosage adjustment in patients with severe renal failure: antifactor xa concentrations and safety.

Study Objective: To evaluate the safety and efficacy, by measuring antifactor Xa levels, of enoxaparin 1 mg/kg subcutaneously once every 24 hours in patients with severe renal failure.

Design: Prospective study.

Setting: Emergency, internal medicine, geriatrics, and cardiology departments of a medical center in Israel.

[Quinines--past and present].

Quinines are known to mankind and have been in medical use against malaria for over 350 years. The revelation of quinines' activity against malaria in the 17th century brought a revolution to the medical world and had dramatic implications on the political arena of Europe at that time. The source of these materials is the bark of the Cinchona trees indigenous to remote mountain areas of Latin America.

Oral maintenance clinical trial with miglustat for type I Gaucher disease: switch from or combination with intravenous enzyme replacement.

Enzyme replacement therapy (ERT) with imiglucerase reduces hepatosplenomegaly and improves hematologic parameters in Gaucher disease type 1 within 6-24 months. Miglustat reduces organomegaly, improves hematologic parameters, and reverses bone marrow infiltration. This trial evaluates miglustat in patients clinically stable on ERT.

Desensitization to hydroxychloroquine--experience of 4 patients.

Hydroxychloroquine (HCQ) is an antimalarial agent with immunomodulatory effects. It is widely used in rheumatologic diseases, and has a very high efficacy/toxicity ratio. It is particularly important in the treatment of systemic lupus erythematosus (SLE) since it reduces new organ involvement and disease flares, and relieves skin and joint symptoms.

Intrathecal methotrexate neurotoxicity: clinical correlates and antidotal treatment.

The neurotoxicity of methotrexate (MTX) is more severe when administered intrathecally (IT) than by the oral and intravenous (IV) routes, and has been reported even with a single administration of therapeutic doses of 12 or 15mg. Prompt recognition and treatment are essential to improve the outcome after massive IT-MTX overdose. Treatment options include CSF drainage or CSF exchange, ventriculolumbar perfusion, IT corticosteroids to reduce CSF inflammation and IV leucovorin to reduce systemic toxicity.

Emergency treatment of life-threatening intrathecal methotrexate overdose.

A male 34-year-old patient with aggressive diffuse malignant lymphoma was hospitalized for treatment. Because of high likelihood of CNS involvement, intrathecal methotrexate (MTX) 15 mg was administered with hydrocortisone 100mg. Shortly after the intrathecal injection the patient became agitated, and complained of severe low back pain and 2h later he became confused and developed generalized seizures.

Clinical effects of locally delivered nicotine in obstructive sleep apnea syndrome.

Obstructive sleep apnea (OSA) is a common disorder characterized by disordered breathing and associated with increased mortality and cardiovascular morbidity. A factor in the pathogenesis of OSA is hypotonia of the upper airway muscles during sleep, resulting in occlusion of the upper airway. Nicotine may be a suitable drug because it is a stimulant of breathing and activity of oropharyngeal muscles.