There is a low incidence of clinically significant tICH with a ground-level fall in head trauma in patients taking an anticoagulant or antiplatelet medication. There was no statistical difference in rate of tICH between antiplatelet and anticoagulants, which is unanticipated and counterintuitive as most literature and teaching suggests a higher rate with anticoagulants. A larger data set is needed to determine if small differences between the groups exist.

Objectives:To evaluate the association between post-concussive symptomatology and heading in professional soccer players, overcoming the bias of self-reported exposure, we evaluated several clinical neuropsychiatric symptoms using questionnaires after a thorough objective follow-up of players heading-exposure throughout an entire seasonMethods:We collected heading data for all Israeli Premier League players for an entire season using a web-based platform for performance analysis, which enabled us to quantify the exact number of headers per player. Players filled questionnaires regarding post-concussion symptoms, depression, anxiety and sleep disorders. We tested the association between the number of headers and each outcome using a negative binomial regression corrected for the hours played.Results:159 players were included, of which 79 considered in the high heading exposure group (49%) defined as more than median number of headings (1.34 per game hour). Among players without any past head injury, those with higher heading exposure were less likely to suffer post-concussion symptoms compared to players with low heading exposure (RR per heading per hour=0.94, 95%CI [0.912;0.963]). Players with high heading exposure suffered less from depression symptoms (RR=0.98, 95%CI [0.961;0.997]), anxiety (RR=0.98, 95%CI [0.958;0.997]) and sleep disorders (RR=0.98, 95%CI [0.961;0.996]).Conclusion:Professional soccer players with high heading rate do not display higher post-concussive symptomatology severity. Symptoms among players with low heading exposure might be explained by low resilience, possibly associated with an inferior heading technique. Alternatively, it can reflect heading avoidant behavior.

Background: Immunosuppression is strongly associated with an increased risk of developing cutaneous squamous cell carcinoma (cSCC). Studies on solid organ transplant recipients (SOTR) and chronic lymphocytic leukemia (CLL) patients have already demonstrated higher rates of aggressive cSCC tumors in these populations compared to immunocompetent controls. Studies on other immunosuppressed patient groups are scarce. This study was aimed at assessing the effects of different immunomodulating conditions on patients diagnosed with cSCC. We sought to compare the clinical features, treatments, and survival rates among the different study groups, as well as outcomes to those of immunocompetent controls with cSCC. Methods: A retrospective analysis of 465 cSCC patients, both immunosuppressed (IS) and immunocompetent controls. Etiologies for immunosuppression included SOTR, CLL, chronic kidney disease (CKD), psoriasis, rheumatoid arthritis (RA) and systemic lupus erythematous (SLE). Results: Compared to the control group, IS patients demonstrated several significant differences. These include higher rates of positive resection margins, higher recurrence rates, and multiple SCC tumors. Patients in the IS group, who were also given immunomodulating agents, demonstrated even lower survival rates. Cox regression analysis demonstrated statistically significant decreased overall survival (OS) rates for IS patients compared to the controls (OR = 1.9, p = 0.031). SOTR patients tend to have multiple cSCC tumors (35%), with the highest number of primary tumors compared to controls (2.54 tumors per patient on average, p < 0.001), but also compared to all other IS groups. The average SCC lesion size in the SOTR group was the smallest, measuring at 13.5 mm, compared to the control group and all other IS groups. Decreased survival rates were seen on Cox regression analysis compared to controls (HR = 2.4, p = 0.001), but also to all other IS groups. CLL patients also had the highest rates of positive margins compared to controls (36% vs. 9%, p < 0.01) and to all other IS groups. They were also most likely to get adjuvant or definitive oncological treatments, either radiotherapy or chemotherapy, compared to controls (36% vs. 15%, p = 0.02) and to other IS groups. Patients in the CKD group demonstrated the highest rates for multiple cSCC (OR = 4.7, p = 0.001) and the worst rates of survival on Cox regression analysis (HR = 3.2, p = 0.001). Both rheumatoid arthritis and psoriasis patients demonstrated the shortest disease-free survival rates (2.9y ± 1.1, 2.3y ± 0.7, respectively), compared to controls (4.1y ± 2.8) and to all other IS groups. Conclusions: Among cSCC patients, immunosuppression due to SOTR, CLL, CKD, RA, and psoriasis is associated with worse outcomes compared to controls and other IS groups. These patients should be regarded as high-risk for developing aggressive cSCC tumors. This study is the first to assess and compare cSCC outcomes among multiple IS patient groups.

A history of intrapartum cervical laceration is an independent risk factor for recurrent cervical lacerations, CD, preterm delivery, and severe perineal lacerations in the subsequent pregnancy.

Introduction:Prosthetic joint infection (PJI) is a potentially catastrophic complication of total joint replacement. Our purpose was to determine whether the use of a silver dressing reduces the incidence of superficial and deep PJI following primary total hip replacement and total knee replacement.Methods:A case-control study of primary total hip replacement and total knee replacement was performed to compare the incidence of superficial and deep PJI in patients who received a silver nylon dressing with patients who received a standard dressing.Results:The incidence of infection was significantly lower in the study group compared with the control group. There were no deep PJIs in the silver dressing group. Twelve patients (2.3%) in the control group developed PJI.Discussion:The use of a silver dressing significantly reduced the incidence of superficial and deep PJI following total joint replacement (P = 0.010). Given the financial impact of PJI, the application of silver dressings may result in considerable cost savings, and a formal cost-benefit analysis could be investigated.

No abstract

Background Numerous studies have confirmed the association of ambient temperature and air pollution with a higher risk of morbidities, yet few have addressed their effect on the ocular system. The purpose of this study was to assess the association between temperature, air pollution, and emergency room visits for conjunctivitis. Methods In this case-crossover study, the records of all emergency room visits to Soroka University Medical Center (SUMC) from 2009 to 2014 were reviewed for patients with conjunctivitis. Daily exposure to fine and coarse particulate matter and temperature were determined by a hybrid model involving satellite sensors. Mean relative humidity was obtained from the Ministry of Environmental Protection meteorological monitoring station located in Beer-Sheva. Results Six hundred one patients were diagnosed with conjunctivitis in the SUMC emergency room. We discovered a positive association between temperature increments and incidence of conjunctivitis. The strongest effect was found during summer and autumn, with an immediate (lag0) incidence increase of 8.1% for each 1 °C increase in temperature (OR = 1.088, 95%CI: 1.046–1.132) between 24 and 28 °C in the summer and 7.2% for each 1 °C increase in temperature (OR = 1.072, 95%CI: 1.036–1.108) between 13 and 23 °C in the autumn. There was no statistically significant association between fine and coarse particulate matter and conjunctivitis incidence. Conclusion Temperature increases during summer and autumn are significantly associated with an increased risk of conjunctivitis. Conjunctivitis is not associated with non-anthropogenic air pollution. These findings may help community clinics and hospital emergency rooms better predict conjunctivitis cases and will hopefully lead to improved prevention efforts that will lower the financial burden on both the individual and the public.

Background Numerous studies have confirmed that ambient temperature and air pollution are associated with higher risk of morbidities to different systems of the human body, yet few have addressed their effect on the ocular system. The purpose of this study is to determine the association between temperature, air pollution and emergency room visits for non-specific conjunctivitis Methods In this retrospective cohort study, the records of all emergency room visits to Soroka University Medical Center (SUMC) from 2009 to 2014 were reviewed for patients with conjunctivitis. Exposure to fine and coarse particulate matter and temperature were assessed by a hybrid model that incorporated daily satellite remote sensing. Results The records of the 6001 patients who visited the SUMC emergency room with conjunctivitis, together with the meteorological data, revealed a positive association between temperature increment and incidence of conjunctivitis. The strongest effect was found during summer and autumn: the incidence increased 8.1% for each 1oC rise in temperature between 24oC and 28oC in the summer, and 7.2% for each 1oC rise in temperature between 13oC and 23oC in autumn. The association between fine and coarse particulate matter and incidence of conjunctivitis was not statistically significant. Conclusion High ambient temperature is significantly associated with an increased risk of nonspecific conjunctivitis in summer and autumn and not in spring and winter. Conjunctivitis is not associated with air pollution. The findings can assist community clinics and hospital emergency rooms prepare for the upticks in the condition during certain seasons and acute rises in temperatures, lowering the financial costs to both the individual and the public.