Harefuah
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Tracheostomy is a surgical procedure, frequently used in patients with respiratory failure requiring prolonged mechanical ventilation. It is associated with fewer complications and may facilitate weaning from mechanical ventilation. Over the past 15 years, bedside percutaneous tracheostomy (PDT) has been widely employed as the primary method for performing tracheostomy in intensive care units. However, the ideal technique and timing for this procedure is still controversial. ⋯ Bedside PDT is a simple, safe and readily available procedure with low morbidity rates when performed by an experienced operator. However, long term outcome remains poor Survival rates were lower among patients who underwent the procedure within ten days of mechanical ventilation.
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Increased longevity raises the proportion of elderly individuals in a population, and thereby, the number of individuals suffering from frailty. Frailty is associated with loss of skeletal muscle mass and function (sarcopenia), which stems from an imbalance between muscle protein synthesis and degradation. Nutrition intake, physical activity (both aerobic and resistance training) and comorbidities are associated with skeletal muscle mass in elderly individuals. ⋯ These differences might reflect gender differences in comorbidity rates. Identification of modifiable risk factors for sarcopenia may lead to intervention opportunities. Further research is needed to determine whether improved skeletal muscle mass impacts survival in this frail elderly nursing home residents.
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The influenza virus is a well-known cause of pandemics, such as the swine flu (A/H1N1) pandemic and of seasonal epidemics worldwide. Most of the morbidity and mortality due to the virus is caused by the seasonal flu epidemics for which the flu vaccine has been proven to be an efficient preventive measure. On the 22nd of October 2006 the Israeli media widely reported the deaths of three patients who had received the flu vaccine at the same clinic in Kiryat Gat. A nationwide panic arose following these publications and many people were afraid to receive the flu vaccine. ⋯ The results of this survey show that the panic in the Israeli media resulted in a very significant reduction in the rate of vaccination with the flu vaccine at the Hadassah Mount Scopus Medical Center during the flu season of 2006-7. This reduction in the rate of vaccination resulted in greater morbidity. We can conclude that many people in Israel became sick and even died due to the flu vaccine scare which was never proved to be justified. There is a need to consider how to avoid a similar media-evoked panic reaction in the future which causes damage to the public's health.
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A first urinary tract infection (UTI) in childhood is more prevalent in females < 5-years-old. Circumcision generally protects males from UTI, however, during the month following the procedure, the prevalence of infection increases up to 12 times in circumcised boys when compared with those not circumcised. Almost all the infections are caused by aerobic Gram-negative bacteria of which E. coli are responsible for 70-90% of the cases. ⋯ Mid stream clean voided urine specimens obtained from circumcised males in the first months of life are also acceptable. Depending on the clinical presentation, oral therapy can begin from as early as two months of age, and the recommended empiric drugs for first febrile UTI are cefuroxime axetil, or amoxicillin clavulanate. Cephlexin is recommended for cystitis.