With more than 100 million confirmed COVID-19 cases as of March 2021, reinfection is still considered to be rare. In light of increasing reports of reinfected COVID-19 patients, the need to better understand the real risk for reinfection is critical, with potential effects on public health policies aimed at containing the spread of SARS-CoV-2. In this descriptive preliminary report, we conducted a large-scale assessment on the country level of the possible occurrence of COVID-19 reinfection within the members of a large healthcare provider in Israel. Out of 149,735 individuals with a documented positive PCR test between March 2020 and January 2021, 154 had two positive PCR tests at least 100 days apart, reflecting a reinfection proportion of 1 per 1000. Given our strict inclusion criteria, we believe these numbers represent true reinfection incidence in MHS and should be clinically regarded as such.

A 2-dose regimen of the BNT162b2 messenger (m) RNA COVID-19 vaccine (Pfizer-BioNTech; Pfizer, New York, NY) has demonstrated 95% efficacy in preventing COVID-19 in a phase III placebo-controlled randomized clinical trial 1 and in real-world data analyses. 2,3 Patients with inflammatory bowel disease (IBD) treated with immune-modifying agents are considered partially immunosuppressed, and thus, the International Organization for the Study of Inflammatory Bowel Disease (IOIBD) recommends that patients with IBD should be vaccinated against COVID-19 and that vaccination should not be deferred in patients receiving immune-modifying therapies. 4 Because patients with immune conditions (including IBD) were excluded from the COVID-19 vaccine clinical trials, it is important to describe accumulating real-world data. 5 In Israel, patients with IBD were given priority for early vaccination in the campaign, which is, as of June 23, 2021, the most extensive worldwide (63.6% of the total population received at least 2 doses, and 59.5% of the population was fully vaccinated). 6 This study is a preliminary report of the effect of mass vaccination in patients with IBD.This retrospective cohort study was conducted using data from the Maccabi Healthcare Services (MHS) central computerized database. MHS is the second largest statemandated health care provider in Israel, covering >2.5 million members (25% of the population) and is a representative sample of the Israeli population.To evaluate vaccine effectiveness, this study included individuals from the MHS IBD registry aged 16 years who received the BNT162b2 mRNA COVID-19 vaccine and matched patients (1:3) who were vaccinated between December 19, 2020 and March 10, 2021. Individual matching was performed based on sex, birth year, coexisting comorbidities, and month of the first vaccination dose. IBD status was defined according to the MHS IBD registry based on physician diagnosis and dispensed medications. 7 The analysis excluded patients with a history of a positive polymerase chain reaction (PCR) result or a diagnosis of COVID-19 any time before the first BNT162b2 vaccination. All eligible patients were required to have a minimum of 30 days of follow-up after the second vaccine dose date, referred to as the "index date," to observe study outcomes. Retrospective follow-up lasted from the index date until April 11, 2021 (details are provided in the Supplementary Text). The MHS Ethics Committee approved the study protocol.The study included 12,231 patients with IBD and 36,254 matched patients. Overall, 50.0% were women, and the mean age was 47 ± 17 years in both groups. Follow-up was a median of 71 days (interquartile range, 52-80 days), and

Background Red blood cell distribution width (RDW) has been assessed during COVID-19 patient hospitalization, however, further research should be done to evaluate RDW from routine community blood tests, before infection, as a risk factor for COVID-19 related hospitalization and mortality. Patients and methods RDW was measured as a predictor along with age, sex, chronic illnesses, and BMI in logistic regressions to predict hospitalization and mortality. Hospitalization and mortality odds ratios (ORs) were estimated with 95% confidence intervals (CI). RDW was evaluated separately as continuous and discrete (High RDW ≥ 14.5) variables. Results Four thousand one hundred and sixty-eight patients were included in this study, where 824 patients (19.8%) had a high RDW value ≥14.5% (High RDW: 64.7% were female, mean age 58 years [±22] vs. Normal RDW: 60.2% female, mean age 46 years [±19]). Eight hundred and twenty-nine patients had a hospitalization, where the median time between positive PCR and hospital entry was 5 [IQR 1–18] days. Models were analyzed with RDW (continuous) and adjusted for age, sex, comorbidities, and BMI suggested an OR of 1.242 [95% CI = 1.187–2.688] for hospitalization and an OR of 2.911 [95% CI = 1.928–4.395] for mortality ( p < .001). RDW (discrete) with the same adjustments presented an OR of 2.232 [95% CI = 1.853–1.300] for hospitalization and an OR of 1.263 [95% CI = 1.166–1.368] for mortality ( p < .001). Conclusions High RDW values obtained from community blood tests are associated with greater odds of hospitalization and mortality for patients with COVID-19. KEY MESSAGES RDW measures before SARS-CoV-2 infection is a predictive factor for hospitalization and mortality. RDW threshold of 14.5% provides high sensitivity and specificity for COVID-19 related mortality, comparatively to other blood tests. Patient records should be accessed by clinicians for prior RDW results, if available, followed by further monitoring.

A 24-hour Holter electrocardiogram (ECG) is frequently employed to detect occult AF following ischaemic CVA or TIA. Real-world data demonstrates detection rates of 1.3% using this method. 24-hour Holter monitoring serves as an initial screening tool, yet a more efficient method for prolonged monitoring should be applied.

Background and Aim In 2017, ustekinumab (UST) was included in Israel's National Basket of Health Services for treatment of biologic‐experienced Crohn's disease (CD) patients with moderately to severely active disease. This study aims to provide real‐world evidence on persistence and clinical outcomes among early users of UST. Methods This retrospective cohort study was conducted using data from Maccabi Healthcare Services (MHS; 2.5‐million‐member state‐mandated health provider, Israel). Adult patients with a CD diagnosis code who had ≥1 dispensed UST prescription in 2017–2018 and at least 12 months of prior continuous health plan enrollment were included. Outcomes, including treatment discontinuation, dose‐escalation (based on shortened intervals between purchases), CD‐related surgery, CD‐related hospitalization, corticosteroid (CS) discontinuation, and use of opioids were evaluated from the date of first dispensed UST through the end of 2019 using Kaplan–Meier analysis. Results A total of 162 eligible patients (81 [49.4%] female; median age 34.4 years [IQR 23.2–46.3]; median years since CD diagnosis 8.6 [IQR 4·8–16.0]) were enrolled in the study. Discontinuation rate after 365 and 540 days of follow‐up was 27.8% and 35.6%. Dose escalation was estimated at 15.4% and 28.6%, respectively. The first‐year cumulative rate of CD‐related surgery and CD‐related hospitalization were estimated at 4.7% and 9.8%, respectively. Conclusion In this real‐world CD cohort of UST users, results suggest persistence is relatively high as compared to other biologics for CD. Comparative effectiveness of different biologic treatments for CD in this population should be further explored.

Summary The Ultra-Orthodox Jewish population has behaviors that can influence the risk for osteoporotic fractures. We investigated whether this population is more prone to osteoporotic fractures than non-Orthodox Jewish. We did not find a significant difference in osteoporotic fracture rates between the two populations despite major differences in exposure to potential risk factors. Introduction The Ultra-Orthodox Jewish population is a conservative population with unique cultural behaviors such as modest clothing and specific dietary restrictions, which can influence bone density and risk for osteoporotic fractures. The aim of this study is to investigate whether the Ultra-Orthodox Jewish population is more prone to osteoporotic fractures than the non-Orthodox Jewish population. Methods This retrospective cohort study utilized computerized records from Maccabi Health Service. Study population included patients 65 years and older without a history of osteoporotic fracture, who reside in regions of Ultra-Orthodox and non-Orthodox Jews. The primary outcome was the adjusted risk to osteoporotic fracture during 9 years of follow-up. Cox regression included patient characteristics and risk factors for osteoporosis. Results A total of 115,134 patients were included in this study: 5397 patients residing in Ultra-Orthodox regions (51.0% female) and 109,737 patients residing in non-Orthodox regions (52.6% female). A total of 16,352 (14.2%) patients had an osteoporotic fracture during the study period. There was no significant difference in fracture rate between Ultra-Orthodox and non-Orthodox (14.3% vs. 14.2%, p = 0.827). Among Ultra-Orthodox and non-Orthodox females and males, there were no significant differences in fracture rates (19.1% vs. 19.1% p = 0.982 and 9.3% vs. 8.8% p = 0.311, respectively). The adjusted hazard risk for the Ultra-Orthodox Jews was 1.026, 95% CI: 0.95–1.11, p = 0.512. Conclusion We did not find a significant difference in the rate of osteoporotic fractures between Ultra-Orthodox and non-Orthodox populations despite major differences in exposure to potential risk factors. Results suggest that the perception of risk factors relevant for the religious communities should be re-evaluated.

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Aims Randomized controlled trials have shown that insulin glargine 300 U/mL (Gla‐300) has a more stable and prolonged glucose lowering effect among patients with type 2 diabetes (T2DM) compared to insulin glargine 100 U/mL (Gla‐100), resulting in a reduced risk of hypoglycaemia while maintaining a similar efficacy of lowering HbA 1c . We aimed to investigate if the effectiveness of Gla‐300 is reproducible in real‐world settings. Material and methods In this retrospective cohort study, data from a large state‐mandated health organization were used to identify adult T2DM patients who were previously on insulin and initiated Gla‐300 therapy between 6/ 2016 and 12/2017. Changes in HbA 1c levels, body weight and insulin dose were calculated from baseline period and over a follow‐up period of 180 days. Documented hypoglycaemia events were also explored. Results A total of 1797 patients were included in this study with a mean age of 64.2 (SD = ±11.0y), baseline HbA 1c was 8.7 ± 1.6% and 42.5% were females. Among all patients with HbA 1c measurement during follow‐up (n = 1508), HbA 1c was significantly reduced by −0.6% (95% CI −0.6,−0.5; P < .001) from baseline, with a significant reduction in body weight (−0.4 kg; P = <.001). Additionally, a significant ( P = .04) reduction of 40.5% in patients with hypoglycaemia events was recorded during follow‐up period, from 2.1% (n = 37) at the baseline period to 1.2% (n = 22). Conclusions This real‐world study supports evidence from RCTs regarding the effectiveness of Gla‐300 among T2DM patients by improving glycaemic control.