Interesting appearance of osseous hemangioma of the calcaneus on bone scintigraphy: correlative imaging with radiography CT and MRI.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
Isaac Ashkenazi
Publications and source records attributed to Isaac Ashkenazi.
Characteristics of skeletal stress fractures in female military recruits of the Israel defense forces on bone scintigraphy.
AIM: Clinical surveys on stress fractures (SF) in female military recruits are scarce. The aim of this study was to characterize the scintigraphic findings and classify the distribution and pattern of SF in a group of female recruits of the Israel Defense Forces (IDF). MATERIALS AND METHODS: The bone scans of 146 female recruits (age range, 19-20.6 years) with suspected SF were assessed retrospectively. The SF lesions were classified qualitatively into 4 grades of bone response according to the classification criteria introduced by Zwas et al. SF location and distribution were analyzed, and in several cases, the abnormalities were correlated radiographically. RESULTS: One hundred forty-six female recruits were examined, of which 93 (64%) had bone scan findings of SF with a total of 247 SF. Forty-eight patients (with or without SF) had shin splints, 32 had thigh splints, and 34 had normal scans. Several SF were detected in sites that were not clinically suspected. Thirty-nine percent of the SF were located in the feet (tarsal bones 22.7%, metatarsal 16.2%), 36.8% in tibiae (predominantly in the midthird), 15.7% in femurs, 6.5% in the pubic and sacroiliac regions, and 2% in the fibula. SF in the tibiae and femurs were mainly located in the posterior aspect of the medial cortical region. Forty-nine percent of the patients had bilateral SF. The SF were classified on a 4-grade scale: 41.3% were grade I, 37.2% grade II, 15.8% grade III, and 5.7% grade IV. Thirty-three percent of the patients had one site of SF, 31% had 2 sites, 7.5% had 3 sites, 12% had 4 sites, 7.5% had 5 sites, and 9% had more than 5 sites of SF. Different grades of lesions were often found in the same patient. Sixty-five percent of the patients had SF in the feet, 59% in the tibiae, 26% in the femurs, 14% in the pubic or sacroiliac regions, and 5% in the fibula. Radiography was performed in 15% of the patients. Only one patient had a positive finding on radiography. CONCLUSIONS: This study shows that lower leg SF are not uncommon in female military recruits. We clearly distinguished between SF and shin splints, which have important clinical consequences on treatment. Most of the SF were mild (grade I and II) located in the feet and tibiae. This study supports the experience gained in other studies, and emphasizes the significant number of pubic and sacroiliac SF in female soldiers, which is significantly higher in comparison with previous reports on male soldiers.
Adult↗
The prevalence of reversible cardiovascular risk factors in Israelis aged 25-55 years.
BACKGROUND: Coronary heart disease is a major cause of morbidity and mortality worldwide. Early detection of cardiovascular risk factors and intervention may reduce consequential morbidity and mortality. OBJECTIVES: To assess the prevalence of reversible and treatable cardiovascular risk factors among 26,477 healthy Israeli adults: 23,339 men and 3138 women aged 25-55 years. METHODS: We collected data during routine examinations performed as part of a screening program for Israel Defense Force personnel. RESULTS: The three most prevalent cardiovascular risk factors were a sedentary lifestyle (64%), dyslipidemia (55.1%) and smoking (26.8%). Overall, 52.9% of the men and 48.4% of the women had two or more cardiovascular risk factors. Moreover, 52.4% of young adult men and 43.3% of young adult women, age 25-34 years, had two or more reversible cardiovascular risk factors. CONCLUSIONS: In this expectedly healthy population there was a high prevalence of reversible and treatable cardiovascular risk factors in both genders and in young ages. These observations stress the need for routine health examinations and lifestyle modification programs even in the young healthy Israeli population.
Adult↗
Serologic testing for celiac disease in young adults--a cost-effect analysis.
In recent years, there has been a marked increase in the diagnostic workups for celiac disease among military personnel, thereby significantly increasing overall laboratory testing expenditures and burden. We evaluated the serologic testing procedure in symptomatic young adults, using a "cost-effect" approach. We evaluated the serologic screening policy for celiac disease among serologically tested military personnel. The study population was divided into subgroups according to the clinical presentation prior to screening: isolated (low-risk) and combined complaints (high-risk). Sensitivity, specificity, and predictive values of serologic markers for celiac disease were evaluated. Cost analyses were based on diagnostic expenditures. Cost-effect ratio is expressed as cost per newly diagnosed patients, and cost minimization as cost per screened individuals. Five hundred thirty-eight military personnel were serologically tested for celiac disease. Eight new cases of celiac were diagnosed, all of whom belonged to the high-risk subgroup and tested positive for at least two positive serologic tests (tTG + EMA or tTG + AGA IgG + EMA). EMA Ab measured the highest sensitivity, specificity, and predictive values. Average screening expenditure was U.S. $287 per patient. The lowest cost-effect and cost minimization ratios were achieved by implementing a two-step single-marker screening protocol for high-risk subjects and one-step follow-up for low-risk subjects. Among patient population of young adults, selective diagnostic workup could result in cost-minimization without risking quality of diagnosis. From a cost-effect perspective, implemented screening procedures need to be dependent on subgroup: low-risk, clinical follow-up; and high-risk, serological testing for EMA and, only if positive, possibly a small-bowel biopsy.
Adult↗
Comparison of health care services for career soldiers throughout the world.
Health care systems operate differently in every country and are products of historical and political factors. We compared health care systems for career soldiers in various countries with those of the Israel Defense Forces. Questionnaires requesting data regarding military health care services provided in their countries were sent to military attaches serving in Israel. The countries for which data were gathered include Argentina, Brazil, Chile, China, England, France, Finland, Germany, Hungary, Israel, Poland, Romania, Spain, and the United States. In most countries, career soldiers receive better health care services than civilians, especially in countries with military rule or under military threat.
Global Health↗
Financial management using a computerized system for evaluating health care invoices.
The Medical Corps of the Israel Defense Forces (IDF) provides health care services for hundreds of thousands of soldiers in IDF clinics and by purchasing services from civilian institutes. Monthly invoices from civilian institutes are so numerous that most are paid with insufficient scrutiny and valuable information regarding soldiers' health care is lost. Our objective was to develop a computerized system for reviewing invoices and gathering data. Based on Oracle software (Oracle, Redwood Shores, California), the system stores the terms of agreements with medical institutes, enters billing data, calculates invoice totals, manages information, and generates reports. It automatically checks for duplicate invoices and confirms payment. The system allows users to view data for decision-making, creates insurance claim files, identifies incorrect charges, assists in quality assurance, and maintains personal patient records. With the system in operation since 2001, savings significantly increased, to approximately 5% of the IDF health care budget. On the basis of information gathered by the system, changes in medical procedures were implemented that are expected to generate even greater savings.
Accounts Payable and Receivable↗
[Tsunami--the death waves].
On December 26, 2004, the fourth strongest earthquake over the past century struck in the Indian Ocean off the western coast of northern Sumatra, Indonesia. Measuring 9.0 in magnitude, the earthquake triggered massive tsunamis that struck the Indian Ocean countries and Somalia, and killed more than tens of thousands and destroyed entire villages, leaving over a million homeless. Tsunamis are water waves that are caused by sudden vertical movement of a large area of the sea floor during an undersea earthquake. Tsunami speed can exceed 800 kilometers per hour, and as it reaches shallow water the height of the wave drastically increases. There are two natural warning signs of a possible tsunami: the earthquake itself and later, in the minutes preceding a tsunami strike, the sea often recedes temporarily from the coast. Despite these warning signs and despite a lag of up to several hours between the earthquake and the impact of the tsunamis, nearly all of the victims were taken completely by surprise. One of the most common myths associated with natural disasters is that dead bodies are responsible for the spread of epidemics. This article discusses the myths that often lead authorities and others to take inappropriate action, and presents valuable lessons to be learned from this catastrophic disaster.
Disasters↗
[Eye cosmetics--the beauty and the beast].
The use of eye cosmetics is a popular practice in modern times that dates back to ancient civilizations. This practice, however, is not without hazards. The most common adverse effect of eye cosmetics is eyelid dermatitis, although an array of other adverse effects has been reported. This article reviews the different types of eye cosmetics in current use, their composition and the adverse effects of both commercial and traditional products.
Cosmetics↗
[Knowledge management in health organizations].
BACKGROUND: In 2002 the head of the Israel Defense Forces (IDF) Technology and Logistics Command took a strategic decision to manage knowledge across the organization. The IDF Medical Corps was one of the initiation sites selected. Insights from the process of establishment of a knowledge management (KM) system in the IDF Medical Corps as a health organization (HO) are described. METHODS: IDF's medical services were identified, mapped and their participants interviewed, as were KM personnel in Israeli HOs. Information analysis pointed to the medical rendezvous (MR) as the central process for initiation of KM. The knowledge challenges were identified, and knowledge services and administrative interventions were planned. RESULTS INCLUDING KM CHALLENGES AND RESPONSE: The MR was found to be the process in which most of the clinically and administratively significant decisions in HO's were taken. Practitioners had large clinical and administrative knowledge gaps. Medical and administrative knowledge originated from various sources, in many formats. It could not be retrieved either easily or completely, was usually presented in an inconvenient form for assimilation, and was not always updated. Therefore, the MR was selected as the initial intervention point. Optimally, a comprehensive solution providing access to high quality knowledge can be a knowledge portal, including diagnostic indexing as a key for retrieval of information. Furthermore, indexed clinical, administrative, services list, quality assurance, risk management, and continuing medical education knowledge services, as well as a collegial and administrative feedback, link all entities involved into a knowledge community. This may increase the opportunity for optimal and efficient managed care.
Health Knowledge, Attitudes, Practice↗
[Unplanned pregnancies among women soldiers in the IDF--an overview].
UNLABELLED: According to the Security Service Law in Israel, a pregnant soldier serving her compulsory military service, who decides to continue with the pregnancy, is discharged from military service. If she wishes to terminate the pregnancy (TOP) and continue serving in the army, she is referred to a civilian pregnancy termination committee. OBJECTIVE: This article aims to examine the incidence of pregnancies amongst soldiers during their compulsory military service (ages 18-20 years) and characterize the populations at risk. METHODS: Data reflecting yearly incidence of pregnancies, number of TOPs, discharges from military duty as a result of continuation of pregnancy and missed abortions amongst soldiers during their compulsory military duty were derived from the military social services records for the period 1997-2003. Socio-demographic variables, number of prior pregnancies, age of pregnancy, means of TOP, relationship with the other parent and his involvement regarding the pregnancy, were obtained from military records between the years 2002-2003. RESULTS: The reported yearly incidence of pregnancies in 1997 was 18.6 per 1000 soldiers during their compulsory military service. In 2003, the incidence rose to 21.5 per 1000. The incidence of continuation of pregnancy, TOPs and missed abortions remained unchanged. Number-wise, the pregnancies occurred most often in Israeli-born, high-school educated young women. When stratifying by country of birth, however, the percentage of pregnancies within subgroups varied significantly. Half of the pregnancies were terminated by pharmaceutical means. In the majority of cases, the pregnancy resulted from a relationship lasting over half a year with a male partner, who was aware of the pregnancy and involved with the decisions regarding its outcome. CONCLUSION: In recent years there has been a rise in the reported yearly incidence of pregnancies among soldiers aged 18-20 years serving their compulsory military service. These findings reiterate the need to increase the efforts in implementing sex education programs amongst educators and the responsible military authorities.
Female↗
Scintigraphic evidence of specific muscle groups: rhabdomyolysis secondary to over-exertion on bone scan.
Explore the source record for details and available documents.
Adult↗
Cycle ergometry estimation of physical fitness among Israeli soldiers.
We evaluated the level of fitness among a large population-based sample of Israeli men and women ages 18-25 years, within the framework of an ongoing survey of personnel discharged from military service in the Israel Defense Force. Aerobic capacity was predicted with the Astrand-Rhyming 6-minute cycle ergometer test and maximal oxygen uptake (VO2 max) was estimated using the Astrand-Rhyming nomogram based on cardiac response to 6 minutes of constant submaximal cycle work. Mean +/- SD VO2 max values were 41.05 +/- 10.52 mL/kg/min for men (range, 15-81 mL/kg/min) and 33.84 +/- 7.60 mL/kg/min for women (range, 16-65 mL/kg/min). Smoking was found to be associated with lower VO2 max among both men and women, whereas type of military service unit was unexpectedly not associated with physical fitness level.
Adult↗
[Characteristics of emergency room admissions of IDF soldiers in northern Israeli hospitals between May 2002 and April 2003].
BACKGROUND: The hospitalization rate of patients visiting the emergency room depends on various parameters including demography, clinical data and other variables. Long term follow-up of hospitalized IDF soldiers reflected variability in hospital admission rate among hospitals and raises the possibility of vastly inappropriate hospitalizations. AIM: The aim of this study was to characterize the admission policy for IDF soldiers in various hospitals, to assess the rate of inappropriate hospitalizations, and to evaluate these costs to the Medical Corps. METHODS: Three hospitals in northern Israel were screened between May 2002 and April 2003, one urban tertiary care hospital (A) and two rural hospitals of different sizes (B and C). One fifth of the discharge forms were randomly screened. Every admission was given a risk evaluation based only on clinical data found upon presentation in the emergency room. One abnormal finding rendered the admission to be considered as appropriate. The rate of admission, lengths of stay, as well as clinical data and utilization of diagnostic tests were recorded and compared. RESULTS: During the study period 65 +/- 1105, 39 +/- 536, and 54 +/- 485 Emergency Room visits were made monthly in hospitals A, B and C, respectively. A total of 1.0% +/- 6.5. 1.4% +/- 12.6 and 2.7% +/- 11.8 of these visits resulted in hospitalization in hospitals A, B and C, respectively. Approximately one quarter of the patients admitted to hospital A were low risk, compared to more than half in the rural hospitals. Low risk admissions were one day shorter in the urban hospital, whereas high risk admissions had the same length of stay. The cost of low risk admissions in the urban hospital was about half of its cost in any of the rural hospitals. The estimated annual cost of low risk admission in all three hospitals screened was about $US 1 million. CONCLUSIONS: The admission rate in the urban hospital was half of its rate in the rural hospitals. Overall, 27% less low risk admissions were made in the urban hospital. The rural hospitals tendency to admit more low risk patients was compounded with their tendency to lengthen these admissions. The reason for this behaviour is not clear, although it may be related to differences in experience and clinical knowledge, consideration of the distance between the hospital and the soldier's home or unit, and financial admission policies.
Emergencies↗
[Jimson weed poisoning].
Datura stramonium abuse causes a potentially lethal anticholinergic intoxication. Today, with the internet widely available, our youth are potentially exposed to partial and quite often dangerous information that systematically disregards the danger of Datura use. The authors suspect that without educational efforts regarding the dark side of Datura use, we shall see a rise in poisoning by this dangerous substance. This review outlines the general management of the intoxication.
Datura stramonium↗
Anticapsular polysaccharide meningococcal antibodies in Israeli military recruits: immune status and the effect of simultaneous administration of immune globulin on the response to polysaccharide vaccine.
The effect of the administration of immune globulin (Ig), given during summer months to prevent hepatitis A, on the immune response to a simultaneously administered quadrivalent meningococcal polysaccharide vaccine (QMPV) was studied in Israeli military recruits. Data were obtained for the first time regarding the immune status of an Israeli population. Anticapsular polysaccharide antibodies were determined using a standardized ELISA assay before, 2 weeks and 3 months after QMPV immunization with or without Ig in two groups of recruits chosen to span the date determining seasonal administration or non-administration of Ig. Pre-vaccination antibody concentrations were > or = 2 microg/ml in 98.4 and 38.9% of subjects against serogroups A and C meningococci, respectively. These levels are consistent with the extremely low incidence of disease due to serogroup A in Israel, and with the previously documented occurrence of serogroup C disease in servicemen and women. Co-administration of Ig was associated with some reduction in antibody concentrations 3 months after vaccination, especially against serogroup A meningococci (P<0.05), but not to an extent likely to be of clinical significance.
Adolescent↗
Measles antibody prevalence rates among young adults in Israel.
BACKGROUND: In Israel, vaccination coverage against measles is high, yet seroepidemiologic studies have shown that more than 15% of the 18-year-old population were unprotected against the disease. A 2-dose program of vaccination against measles, mumps, and rubella at the ages of 1 and 6 years was begun in 1990, supplemented by a measles catch-up plan for all 13-year-olds. The aim of this study was to assess the prevalence of antimeasles antibodies at induction to the Israel Defense Forces in the first doubly vaccinated birth-cohort. METHODS: In 1996, serum samples of 540 recruits, 339 men and 201 women, were tested for measles virus antibody. Findings were compared with surveys conducted in 1987 and 1990. RESULTS: Measles antibodies were present in 95.6% (95% CI, 93.5-97.1) of the recruits. Antibody prevalence was higher in women than in men (99% vs 93.5%; P =.0096). A slightly lower seroprevalence was found in recruits born in the former Soviet Union. The results were substantially higher than the seroprevalence rates found in 1987 (73.3%) and 1990 (84.6%). CONCLUSIONS: The high prevalence of antimeasles antibodies in the young adult population in Israel points to the success of the double-vaccination policy in promoting immunity against the disease.
Adolescent↗