Drorit Merkel

Changes in parameters of oxidative stress and free iron biomarkers during treatment with deferasirox in iron-overloaded patients with myelodysplastic syndromes

Approximately 60–80% of patients with myelodysplastic syndromes (MDS) present with symptomatic anemia and, of these, 80–90% will require red blood cell (RBC) transfusions as supportive therapy.[1][1],[2][2] Excess transfusional iron causes accumulation of labile plasma iron (LPI), the

Differences in physical fitness of male and female recruits in gender-integrated army basic training.

PURPOSE To evaluate gender differences in physical fitness before and after a 4-month gender-integrated basic training (BT) course and to determine whether this program effectively narrowed the differences between male and female soldiers in physical fitness parameters. METHODS One hundred and thirty-seven soldiers (109 females and 28 males) successfully completed a 4-month BT course in the Israeli Defense Forces (IDF). The subjects physical fitness was evaluated pre- and post-BT by three laboratory tests [the maximal aerobic capacity (VO2max), the Leonardo Ground Reaction Force Plate, and the Wingate Anaerobic Test (WAnT)] and by the IDF physical fitness test (IDF-PT). RESULTS Females significantly improved their scores in the IDF-PT and laboratory aerobic tests, whereas males significantly improved only in the IDF-PT. After BT, gender differences narrowed by approximately 4% in all tests except upper body strength. Although fitness improvement after BT was marginally higher in females than males, resulting in a slight narrowing of the gender differences, a significant gender gap in physical fitness still exists after BT. CONCLUSIONS There was only a small overlap in physical abilities at the beginning of BT, which indicated vast differences in physical fitness between the genders. As expected, integrated combat BT improved physical fitness. Although females demonstrated marginally higher improvement in aerobic capacity, basic physiological gender differences were still evident at the end of the training regimen.

Anemia, Iron Deficiency, and Stress Fractures in Female Combatants During 16 Months

Yanovich, R, Merkel, D, Israeli, E, Evans, RK, Erlich, T, and Moran, DS. Anemia, iron deficiency, and stress fractures in female combatants during 16 months. J Strength Cond Res 25(12): 3412–3421, 2011—The purpose of this study is to evaluate the hematological profile of military recruits in different settings and training programs and to investigate the link between anemia and iron deficiency with stress fracture (SF) occurrence. We surveyed 3 groups of recruits for 16 months: 221 women (F) and 78 men (M) from 3 different platoons of a gender-integrated combat battalion and a control group (CF) of 121 female soldiers from a noncombat unit. Data were fully collected upon induction and at 4 and 16 months from 48F, 21M, and 31CF. Blood tests, anthropometry, physical aerobic fitness, and SF occurrence were evaluated. On induction day, 18.0 and 19.0% of F and CF were found to be anemic, and 61.4 and 50.9%, respectively, were found to have iron deficiency, whereas 7.7% of M were found to be anemic and 10.2% iron deficient. During the 4 months of army basic training (ABT), anemia and iron deficiency prevalence did not change significantly in any group. After 16-months, anemia prevalence decreased by 8% among F and CF and abated in M. Iron deficiency was prevalent in 50.0, 59.4, and 18.8% of F, CF, and M, respectively. Stress fractures were diagnosed in 14 F during ABT, and they had a significantly higher prevalence (p < 0.05) of anemia and iron deficiency anemia compared to F without SFs. The observed link between anemia and iron deficiency on recruitment day and SFs suggests the importance of screening female combat recruits for these deficiencies. To minimize the health impact of army service on female soldiers, preventative measures related to anemia and iron deficiency should be administered. Further research is needed for evaluating the influence of low iron in kosher meat as a possible explanation for the high prevalence of iron deficiency among young Israeli recruits.

Iron deficiency and the role of nutrition among female military recruits.

UNLABELLED The impact of iron deficiency is considerable when enhanced physical fitness is required. Female military recruits represent a unique population faced with intense physical and cognitive demands. PURPOSE To examine the prevalence of iron deficiency and the impact of dietary habits among female recruits in the Israel Defense Forces. METHODS Three hundred and forty-eight recruits completed the study (188 female combatants, 58 male combatants, and 92 noncombat females). Dietary intake was assessed using a Food Frequency Questionnaire. Blood samples were collected for complete blood cell count, iron indices, and vitamin B12. The common definitions for anemia and iron store deficiency were used as follows: hemoglobin <12 g x dL for females and <14 g x dL for males; serum ferritin <12 mg x dL. RESULTS The prevalence of iron deficiency and iron deficiency anemia was 29.8% and 12.8%, respectively, among female combatants. Similar data were found among noncombat females (27.2% and 17.4%, respectively) as compared with 5.2% and 0% among males. No significant difference in iron or total calorie intake was detected between subjects with iron deficiency (with or without anemia) when compared with subjects with normal iron status in the same study group. Plant sources constituted 85% of dietary iron source for females, in comparison to 73% for males. The contribution of red meat to the daily iron intake was 2% for females and 20% for males. CONCLUSIONS A high prevalence of iron deficiency was found among female recruits. Coupled with the iron loss during menstruation, inadequate iron intake may have a permissive role for iron deficiency in female recruits and is an important issue facing females in the military.

Value of Preemployment Medical Assessments for White-Collar Workers

Employee absenteeism as a result of illness, as well as the need to enhance worker efficiency, are areas of increasing concern to employers. Given that preemployment medical assessments are expensive, the authors believe it is prudent to evaluate the cost-effectiveness of such procedures. Medical literature was reviewed, and relevant studies on preemployment assessments were analyzed in terms of yield and methodology. The authors found no clear guidelines for preemployment medical evaluations for white-collar applicants, who typically work in low-risk environments; however, they did conclude that laboratory testing and imaging methods are likely overused. Clear criteria should exist for medical assessment of job applicants, with an emphasis on cost-effectiveness. On the basis of recommendations contained in the literature, the authors suggest use of a self-administered questionnaire, with evaluation by an occupational health staff member when necessary, as the method(s) of choice for preemployment assessment of white-collar workers.

The Fitness-for-Work Evaluation of a Young Patient with Essential Thrombocythemia

We describe a case of a military cadet, a candidate for submarine service, who was diagnosed with essential thrombocythemia (ET). The estimated risk in the literature for major clinical complications in ET patients is about 5–20%. Our report concerns a young asymptomatic patient where the estimated risk is probably much lower. We think that the activity in the marine corps, which at times is involved with some degree of dehydration, might increase the risk for thromboembolic events. The possibility of a major thromboembolic complication occurring at sea could complicate and endanger the patient’s life, especially when an evacuation to a hospital is required. A submarine officer has a responsibility to other people’s life who depend on his skills and ability. In case of a major complication which can cause sudden incapacitation, the consequences can be catastrophic to many. Opposed to the considerations to disqualify the young cadet stands the fact that his training was expensive, and that it would be unfortunate to disqualify a very talented young person. We thus recommended to clear the cadet as a marine officer in teaching jobs, in sites were medical assistance is available in a short period of time. In our opinion he should be disqualified from serving in combat jobs where there is a greater risk for him and for the men under his command.