Israel journal of medical sciences
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Clinical Trial Controlled Clinical Trial
The effect of pyridostigmine on respiratory function in healthy and asthmatic volunteers.
Respiratory function was evaluated in 12 healthy and 13 asthmatic volunteers following a single oral dose of pyridostigmine in a double-blind, placebo-controlled cross-over study. Respiratory function tests were performed at rest and after submaximal exercise at the time corresponding to the expected peak cholinesterase inhibition by pyridostigmine. A single dose of 60 mg pyridostigmine given to nonasthmatic subjects led to a decrease of 28.4% in cholinesterase activity when compared to the baseline and a statistically (but not physiologically) significant decrease in FEV1 (forced expiratory volume in 1 sec) both at rest (P less than 0.015) and after exercise (P less than 0.05). ⋯ However, no changes in respiratory function were observed when compared with the effects of placebo. The effect of post-exertion atropine inhalation on respiratory function was also unchanged with pyridostigmine at that dose. We conclude that, in general, at this dose pyridostigmine is a safe drug for asthmatics; however, the distribution of individual results in this group cannot preclude the existence of a subpopulation of asthmatic patients who are more vulnerable to the effects of pyridostigmine.
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Adequate staffing of hospitals during a prolonged, potentially unconventional war is a key component in the disaster plan of institutions. In an attempt to determine policy regarding hospital staffing, a state-wide survey was conducted in Israel among hospital personnel during the recent Persian Gulf war. This survey aimed to explore the willingness of staff to report to their duties (WTR) following an unconventional missile attack described in a hypothetical scenario. ⋯ Males, personnel with headquarter duty of hospital site managers, and parents of children older than 14 years of age, were the most WTR. The finding of extensive interhospital variation in WTR indicates the need for evaluating WTR on an institutional basis when establishing both the hospital and the regional disaster plan. Data are presented on the extent of WTR, the factors inhibiting WTR, and possible measures to improve WTR.
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The Israeli civilian-military health services contingency program for mass and wartime casualties has more than four decades of experience. The contingency program includes key civilian and military organizations that are involved in the planning, policy making and delivery of health care and support services to the wounded. During the Persian Gulf war the unified civilian and military command--the supreme hospitalization authority--implemented a national hospital and emergency medical services preparedness system designed to treat the victims of chemical warfare attacks.
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Patients admitted for elective surgery (inguinal hernia, varicose veins and hemorrhoids) were studied in order to evaluate the impact of performing pre-admission testing (PAT) by utilizing an automated multiphasic health testing (AMHT) technology on the rate of repeating the pre-operative routine laboratory tests during hospitalization. A slightly lower but statistically significant rate of repeated tests was found among patients who performed PAT by AMHTS compared with those who performed the tests via the conventional ambulatory system. This result suggests that performing routine tests before hospitalization in a single authorized AMHTS facility is preferred since it saves the patient time and reduces the need for repeated tests.
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The present report analyzes 116 penetrating wounds of the brain sustained during warfare in Lebanon during 1982-85. Two basic mechanisms of injury were encountered: high-velocity bullets, and shrapnel and stones from explosive devices; and in one case a radio antenna penetrated the head through the orbit. The site of impact was at the convexity in 87% of cases and at the base of the skull in the remaining 13%. ⋯ A follow-up study of the 49 Israeli survivors for almost 6 years revealed intracerebral-retained bone fragments in 48%, but these did not result in increased immediate or late complications (e.g., infection, epilepsy). These results support our conservative approach. Since all victims of penetrating head injuries were evacuated from Lebanon to Rambam Medical Center, Haifa, our report can serve as an estimation of the incidence of penetrating brain wounds and their burden on a front-line hospital.