R. Beigel, D. Oieru, O. Goitein, P. Chouraqui, M.S. Feinberg, S. Brosh, E. Asher, E. Konen, A. Shamiss, M. Eldar, H. Hod, J. Or and S. Matetzky
Background: Many patients present to the emergency department with chest pain. While in most of them chest pain represents a benign complaint, in some patients it underlies a life-threatening illness.
Objectives: To assess the routine evaluation of patients presenting to the ED with acute chest pain via the utilization of a cardiologist-based chest pain unit using different non-invasive imaging modalities.
Methods: We evaluated the records of 1055 consecutive patients who presented to the ED with complaints of chest pain and were admitted to the CPU. After an observation period and according to the decision of the attending cardiologist, patients underwent myocardial perfusion scintigraphy, multidetector computed tomography, or stress echocardiography.
Results: The CPU attending cardiologist did not prescribe non-invasive evaluation for 108 of the 1055 patients, who were either admitted (58 patients) or discharged (50 patients) after an observation period. Of those remaining, 445 patients underwent MDCT, 444 MPS, and 58 stress echocardiography. Altogether, 907 patients (86%) were discharged from the CPU. During an average period of 236 ± 223 days, 25 patients (3.1%) were readmitted due to chest pain of suspected cardiac origin, and only 8 patients (0.9%) suffered a major adverse cardiovascular event.
Conclusions: Utilization of the CPU enabled a rapid and thorough evaluation of the patients’ primary complaint, thereby reducing hospitalization costs and occupancy on the one hand and avoiding misdiagnosis in discharged patients on the other.
ED = emergency department
CPU = chest pain unit
MDCT = multidetector computed tomography
MPS = myocardial perfusion scintigraphy
A. Itsekson, D. Shepshelovich, A. Kanevsky and D.S. Seidman
Background: Non-invasive screening tests may allow early diagnosis and prompt treatment, thereby potentially reducing morbidity and mortality and reducing costs for the community. This may be especially important for gynecologic pathologies that are difficult to promptly diagnose, such as endometriosis or ovarian cancer.
Objectives: To evaluate the reliability of measuring skin resistance using the Medex Test for screening and diagnosis of gynecologic pathologies in a blinded single-center study.
Methods: We enrolled 150 patients: 59 with a functional disorder and 91 with an organic disease. Measurements were carried out in all patients and the results were analyzed separately by a second physician who was blinded to the patients’ diagnosis.
Results: A high correlation was found between the clinical diagnosis and the results of the measurement of electrical skin resistance, with a specificity of 76.3% (45/59) for functional disorders and a sensitivity of 85.7% (78/91) for organic disorders, positive predictive value of 84.8% (78/92) and negative predictive value 77.6% (45/58). The kappa value for the results was 0.622, representing a value much better than expected randomly.
Conclusions: The Medex Test has a good specificity and a high sensitivity for the diagnosis of gynecologic disorders. Further prospective studies are needed to validate these preliminary findings.
J. Dubnov, W. Kassabri, B. Bisharat and S. Rishpon
Background: Health care workers bear the risk of both contracting influenza from patients and transmitting it to them. Although influenza vaccine is the most effective and safest public health measure against influenza and its complications, and despite recommendations that HCWs[1] should be vaccinated, influenza vaccination coverage among them remains low.
Objectives: To characterize influenza vaccination coverage and its determinants among employees in an Arab hospital in Israel.
Methods: An anonymous, self-administered questionnaire was distributed among employees involved in patient care in the winter of 2004–2005 at Nazareth Hospital in Israel. The questionnaire included items related to health demographic characteristics, health behaviors and attitudes, knowledge and attitude concerning influenza vaccination, and whether the respondent had received the influenza vaccine during the previous winter or any other winter.
Results: The overall rate of questionnaire return was 66%; 256 employees participated in the study. The immunization coverage rate was 16.4%, similar to that reported for other hospitals in Israel. Logistic regression analysis demonstrated a significant association only between influenza vaccination coverage and the presence of chronic illness and influenza vaccination in the past.
Conclusions: Influenza vaccination coverage among Nazareth Hospital health care workers was low. They did not view themselves as different to the general population with regard to vaccination. An intervention program was launched after the study period, aimed at increasing the knowledge on the efficacy and safety of the vaccine, stressing the importance of vaccinating HCWs, and administering the vaccine at the workplace. The program raised the vaccination coverage to 50%.
N. Bilenko, I. Belmaker, H. Vardi and D. Fraser
Background: The rates of anemia in children in southern Israel are high despite the current prevention strategy. A daily dose of Sprinkles (SuppleForteTM, Heinz, Canada), a micronutrient home supplementation, was proven effective for the treatment of anemia worldwide.
Objectives: To assess the efficacy of Sprinkles, a novel supplementation formulation, in the primary prevention of anemia in infants who have free access to health care services. Methods: A two-arm open-labeled cluster randomized controlled clinical trial was performed in 6 month old Bedouin and Jewish infants. The Sprinkles arm received sachets with iron, vitamins A and C, folic acid and zinc, and the control arm received standard treatment (liquid iron and vitamins A and D). The infants were from families attending Maternal and Child Health clinics during 2005–2008. Intervention and follow-up were conducted for babies aged 6–12 months. Health outcomes (hematologic and nutritional indicators, growth parameters, morbidity rates) were evaluated at 12 and 18 months.
Results: The final study population numbered 621 infants (328 Bedouin and 293 Jewish) of the parents approached 88.5% agreed to participate. Hemoglobin above 11 g/dl was found in 55% of Bedouin and 40% of Jewish infants (P < 0.01). Bedouin infants had significantly lower serum concentration of iron, folic acid and zinc. All background, hematologic and micronutrient indicators were similar in the two study arms except for a slightly but not clinically significant difference in hemoglobin and hematocrit levels in Bedouins.
Conclusions: Our findings indicate the need to improve the micronutrient status of infants living in the Negev. A cluster randomized trial in MCH[1] clinics is a feasible option.
[1] MHC = mother and child health
R. Cleper, M. Davidovits, Y. Kovalski, D. Samsonov, J. Amir and I. Krause
Background: Peritonitis is a major complication of chronic peritoneal dialysis therapy. It is recommended that each center monitor infection rates in order to define the local microbiological profile and implement an appropriate empiric antibiotic regimen.
Objectives: To analyze the microbiological profile of peritonitis in our pediatric dialysis unit and identify local predisposing factors.
Methods: In this retrospective study we reviewed the files of children treated with chronic PD[1] during the 10 year period 1997–2007.
Results: Eighty peritonitis episodes were recorded in 29 children (20 male, 9 female) aged 0.1–18.5 years (median 11.75) treated with peritoneal dialysis for 6–69 months (median 19) for a total of 578 patient-months. The annual peritonitis rate was 1.66/patient. The main pathogens were coagulase-negative Staphyloccocus (32.5%) and Pseudomonas spp. (16%), which were also cultured in most cases (64–69%) from the exit site during the 3 months preceding peritonitis. No peritonitis occurred in 31% of the patients (median age 12.5 years). All patients less than 5 years old had at least one peritonitis episode. Contaminating conditions (gastrostomy, enuresis, diaper use), found in 44% of the study group, and first infection within 6 months from starting PD were significantly associated with an increased peritonitis rate (P = 0.01, P = 0.009, respectively). Recurrent peritonitis led to a switch to hemodialysis in 18% of patients. There were no deaths.
Conclusions: The risk factors for peritonitis in our study were: first infection within less than 6 months from starting treatment, Pseudomonas exit-site colonization, and contaminating conditions (gastrostomies, diaper use, enuresis). These susceptible subgroups as well as very young age (< 5 years) at starting PD should be especially targeted during training of caregivers and follow-up to prevent later complications.
[1] PD = peritoneal dialysis
A. Yosepovich, C. Avivi, J. Bar, S. Polak-Charcon, C. Mardoukh and I. Barshack
Background: HER2 is an important prognostic and predictive marker in invasive breast cancer. It is currently assessed by immunohistochemistry for protein over-expression and by fluorescence in situ hybridization for gene amplification. The immunohistochemistry-equivocal cases (2+) are currently retested by FISH[1] to determine eligibility for trastuzumab treatment. Retesting by FISH significantly raises the cost of patient management and sometimes delays treatment. The 4B5 is a new, FDA-approved, rabbit monoclonal antibody for HER2 testing.
Objectives: To examine the reliability of 4B5 IHC[2] HER2 testing in cases found to be HER2 status equivocal by CB11 IHC.
Methods: Twenty-eight invasive breast cancer cases, with an equivocal HER2 status by CB11 IHC, were retested by the 4B5 antibody as well as by FISH analysis. The scoring was performed using the same guidelines as HercepTest and was correlated with the FISH ratio. Results: Of the original 28 CB11 clone designated equivocal cases, 14 (50%) showed negative HER2 staining using the 4B5 clone (HercepTest score 0 and 1+). Five cases (18%) proved to be positive (HercepTest score 3+) and 9 cases (32%) remained equivocal (HercepTest score 2+). The corresponding FISH ratio results showed that all 4B5 negative cases were negative by FISH testing, with a negative predictive value of 100% 4 of 5 of the 4B5-positive cases were positive by FISH testing, with a positive predictive value of 80%. One 4B5-positive case was borderline-high (2.2 ratio) by FISH. The correlation between 4B5 IHC and FISH was statistically significant (P = 0.0013) by chi-square test.
Conclusions: Sequential testing by 4B5 IHC could greatly reduce the need for FISH testing in cases considered HER2 equivocal by CB11 IHC.
[1] FISH = fluorescence in situ hybridization
[2] IHC = immunohistochemistry