Orly Weinstein

Bilateral acute anterior uveitis as a presenting symptom of Mycoplasma pneumoniae infection

CASE REPORT To report a case of severe bilateral anterior uveitis associated with Mycoplasma pneumoniae without pulmonary manifestations. COMMENTS A healthy 5-year-old girl developed severe bilateral anterior uveitis accompanied by fever, arthralgia, gastrointestinal complaints, and lethargy. Results of laboratory investigations were normal except for high levels of Mycoplasma pneumoniae antibodies. The uveitis subsided with topical application of steroids, cycloplegia, and with oral azithromycin. Although Mycoplasma pneumoniae is a rare cause of uveitis, it should be considered in patients presenting with uveitis, even with no accompanying pulmonary or other typical systemic mycoplasmal manifestations.

Acetaminophen (paracetamol) levels in human tears

This study was designed to measure acetaminophen (paracetamol) levels in tears, and to compare it to serum levels. Paracetamol levels were measured in 20 paired tears and serum samples from 10 healthy volunteers, 1 and 2 hours after ingesting 1.5 g paracetamol. Tears were collected using glass microcapillary tubes while stimulating the conjunctiva with a small sponge placed in the lower fornix. Blood samples were taken simultaneously. The samples were analyzed for paracetamol levels using homogeneous enzyme immunoassay. Tears and serum paracetamol levels 1 hour after ingestion were 16.3 microg/mL +/- 7.2 (mean +/- SD), and 21.4 microg/mL +/- 7.7 (mean +/- SD) respectively. Tears and serum levels 2 hours after ingestion were 14.4 microg/mL +/- 7.8 (mean +/- SD), and 17 microg/mL +/- 7.6 (mean +/- SD) respectively. Tears and serum paracetamol levels of all the 20 paired samples (1 h and 2 h after ingestion) were 15.35 microg/mL +/- 7.4, and 19.25 microg/mL +/- 7.8, respectively (mean +/- SD). There was a strong and highly significant correlation between paracetamol levels in serum and in tears 1 and 2 hours after ingestion (r = 0.8, p = 0.005, r = 0.85, p = 0.002 respectively). Mean +/- SD ratio of tears/serum paracetamol levels 1 hour and 2 hours after ingestion were 0.77 +/- 0.21 and 0.81 +/- 0.25 respectively. Delta tears (difference in mean levels at 1 and 2 hours) paracetamol levels is significantly correlated with delta serum levels (r = 0.7, p = 0.025). A reliable, convenient, and feasible noninvasive method is described for measuring paracetamol in tears. There is no information in the literature about tears paracetamol secretion, and little information of tears drugs concentration.

Tear/Plasma Urea Ratio as a Correction Coefficient for Drug Monitoring in Tears

Objective: To formulate the tear/plasma urea ratio as a coefficient for correcting drug concentrations in tears. Subjects and Methods: Urea concentrations were measured in 14 paired tear and plasma samples from seven healthy adult volunteers (3 women, 4 men). A second sample was obtained one hour after the first. The samples were simultaneously assayed for urea concentrations by a urease method (Boehringer Mannheim). Results: Our data show a highly significant correlation between tear and plasma urea concentrations in all the samples (r = 0.985, p < 0.001; r = 0.928, p < 0.003; and r = 0.944, p < 0.001 in the first, second, and total collection of samples, respectively). In all paired tear and plasma samples, urea content in tears was higher than in plasma (p < 0.001, p < 0.015, and p < 0.001 in the first, second, and total samples, respectively). The tear/plasma urea ratio in all samples ranged from 1.016 to 1.225 (mean ± SD 1.126 ± 0.068) and had a significant negative correlation (r = −0.538; p < 0.05) with tear volume (range 25–155 μL, mean ± SD 83.9 ± 42.6). Conclusions: Higher urea concentrations in tears than in plasma and a negative correlation between tear volume and the tear/plasma urea ratio indicate that tear evaporation and, consequently, tear concentration occur during sample collection. These data and the highly significant correlation between tear and plasma urea concentrations justify the use of the tear/plasma urea ratio as a correction coefficient for monitoring drug concentrations in tears.

Ballistic Eye Protection: Why Are Soldiers Reluctant to Use Them?

INTRODUCTION The Israel Defense Forces (IDF), as well as many other armies, faces major challenges in balancing the need to protect soldiers from harm while not impeding their ability to fight. Eye protections available in the IDF are underused, for reasons that are as yet unclear. In this study, we aim to gain a better understanding of the influence of eye protection currently in use in the IDF on vision. MATERIALS AND METHODS In this cross-sectional study, subjects were assessed for best corrected visual acuity, contrast sensitivity, and binocular visual fields (Goldmann) in a crossover design (with and without eye protection). In addition, we established a comprehensive review on the subjective faults of the eye protection, both from personal experiences of soldiers who used them during their military service and from civilian volunteers who used them in a sterile laboratory setting. RESULTS Visual acuity, contrast sensitivity and visual fields with and without the eye protection were assessed in 25 subjects. Eye protection did not cause any statistically significant change in visual acuity. However, the eye protection caused a statistically significant decrease in visual fields in all quadrants and in both isopters used. CONCLUSIONS Significant restriction of the visual field can pose a major challenge for soldiers on the battlefield. The use of eye protection with wider lenses or no frame should be considered. Education and instruction should focus on increasing awareness among commanders and soldiers of the benefits of eye protection and fostering trust in the technologys capabilities. In parallel, it is crucial to educate soldiers about its disadvantages, and how such disadvantages can be overcome. We stipulate the findings to the standard IDF goggle and might not apply to other designs.

Healthcare services utilization following admission for hip fracture in elderly patients

Objectives To assess the effect of hip fracture on healthcare utilization among elderly patients. Design Retrospective cohort study. Setting Eight general hospitals in Israel, owned by Clalit. Participants Enrollees >65 years, admitted with a hip fracture during 2009-2013. Main outcome measures Data collected included demographics, comorbidities, admission details related to the surgical and rehabilitation hospitalizations, mortality and costs. Mean monthly costs before and after the event were compared. Quantile regression was used to analyze associations between patient characteristics and healthcare expenditure in univariate and multivariate analysis. Results Of 9650 patients admitted with hip fracture during the study period, 6880 (71%) were Clalit enrollees and included in the present study (69% females, median age: 83 years). Total mean monthly costs increased by 96% during the follow-up year (

Sequence variants in HTRA1 and LOC387715/ARMS2 and phenotype and response to photodynamic therapy in neovascular age-related macular degeneration in populations from Israel.

1470 vs.

Intravitreal bevacizumab (avastin) for subfoveal neovascular age-related macular degeneration

749). Costs for rehabilitation accounted for 40% of costs during the first follow-up year. Mean monthly non-rehabilitation costs increased by 21% (

Broth Culture Yield vs Traditional Approach in the Work-up of Endophthalmitis

877 vs.

Clinical manifestations of adult tubulointerstitial nephritis and uveitis (TINU) syndrome

722). Several factors were found to be consistently associated with increased mean monthly costs during the follow-up year. These included Charlsons comorbidity index, hypertension, baseline expenditure in the base year, the location of the fracture, procedure performed, department on admission, admission to the intensive care unit, discharge to a rehabilitation facility and mortality during the follow-up year. Conclusions Hip fractures in adults in Israel are associated with a significant increase in healthcare utilization and costs. The largest increment was seen in costs for rehabilitation. However, increased costs were noted in all sub-categories of healthcare costs.