Bikur Cholim Hospital (Hebrew: בית החולים ביקור חולים) was a 200-bed general hospital in West Jerusalem, established in the 19th century and closed due to financial difficulties in the second decade of the 21st century. Until then, it was the oldest hospital in the country still operating.Bikur Cholim had obstetrics and cardiac departments, a modern neonatal intensive care unit, a pediatrics department, and bariatric and plastic surgery units. After 2010 it treated some 60,000 patients annually. With 700 administrators, doctors, nurses, technicians and cleaners, it was one of Jerusalem's largest downtown employers. One-third of the doctors were Israeli Arabs, many of whom chose Bikur Holim for their residencies.In December 2012 the hospital was taken over by Shaare Zedek Medical Center and continued to function as a branch of Shaare Zedek. The main hospital was then closed down, with the building on Haneviim (Prophets') Street, the maternity ward, which serves the residents of the nearby neighborhoods and various clinics, continuing to operate. At the same time, plans were submitted to the planning authorities for the restoration of the historic structure and its integration into a complex that includes commercial and housing areas. In 2020 the authorities have decided to also close the maternity ward, following guidelines which require such wards be located next to hospitals that can provide special medical services in case they are needed.
Despite the high accuracy of AI-based automated analysis of 12-lead ECG images for classification of cardiac conditions, clinical integration of such tools is hindered by limited interpretability of model recommendations. We aim to demonstrate the feasibility of a generic, clinical resource interpretability tool for AI models analyzing digitized 12-lead ECG images. To this end, we utilized the sensitivity of the Jacobian matrix to compute the gradient of the classifier for each pixel and provide medical relevance interpretability. Our methodology was validated using a dataset consisting of 79,226 labeled scanned ECG images, 11,316 unlabeled and 1807 labeled images obtained via mobile camera in clinical settings. The tool provided interpretability for both morphological and arrhythmogenic conditions, highlighting features in terms understandable to physician. It also emphasized significant signal features indicating the absence of certain cardiac conditions. High correlation was achieved between our method of interpretability and gold standard interpretations of 3 electrophysiologists.
Introduction: Antenatal corticosteroids (ACS) administration before anticipated preterm birth is one of the most important interventions available to improve neonatal outcomes. Nevertheless, this treatment is associated with an increased risk of neonatal hypoglycemia. The aim of this study was to determine whether preterm twins who receive ACS are at increased risk for developing neonatal hypoglycemia. Methods: This was a retrospective cohort study of indicated and spontaneous preterm births of twins at a single center between 2011 and 2018. The study population included 3 groups matched for gestational age at delivery and birth weight: (1) Twin neonates who received a course of ACS 1-7 days before birth (n = 532); (2) twins who did not receive ACS at that time interval (n = 532); and (3) singletons receiving ACS 1-7 days before birth (n = 266). The primary outcome was neonatal hypoglycemia (<40 mg/dL/2.2 mmol/L) within the first 24 h and 48 h of life. Results: The rate of neonatal hypoglycemia during the first 24 h of life was significantly higher in singletons exposed to ACS compared to twins not exposed to ACS (p = 0.019) and in twins exposed to ACS compared to twins not exposed to ACS (p = 0.047). The rate of neonatal hypoglycemia was almost identical between twins and singletons exposed to ACS (p = 0.72). Regression analysis revealed that exposure to ACS and birth weight were independently associated with neonatal hypoglycemia after adjustment for maternal age, body mass index, gravidity, gestational diabetes mellitus, and gestational age at delivery. Conclusion: Exposure to ACS, rather than plurality, is associated with short-lived neonatal hypoglycemia.
Lung cancer is uncommon among people with cystic fibrosis (pwCF). We describe the case of a 35-year-old man with mild, stable CF disease who presented with severe respiratory distress, systemic symptoms, elevated liver enzymes and hypereosinophilia along with a lung mass and pleural effusion. The patient was subsequently diagnosed with non-small cell lung carcinoma (NSCLC), featuring anaplastic lymphoma kinase (ALK) translocation. Following treatment with a targeted tyrosine kinase inhibitor (TKI) there was a rapid tumor regression, however, his dyspnea and hypoxemia subsequently worsened. A trial of Elexacaftor/Tezacaftor/Ivacaftor (ETI) led to significant clinical improvement and enhanced pulmonary function. In vitro testing using patient-derived intestinal organoids was performed in parallel and also demonstrated a significant response to ETI. The deterioration observed following the initiation of ALK inhibitor treatment and subsequent improvement with CFTR modulators suggest that ALK inhibitor therapy may potentially impair CFTR activity. A better understanding of the relationship between these pathways could provide valuable insights and contribute to the development of more effective and tailored treatment strategies for patients with coexisting conditions. To our knowledge, this is the first reported case of ALK-translocated lung cancer in a CF patient, underscoring the necessity for a high degree of clinical suspicion in atypical presentations of pulmonary exacerbation and potentially linking ALK-EML4 activation pathways, TKI therapy and CFTR. Care for pwCF with lung cancer requires a unique multi-disciplinary approach to optimize their complex multifactorial treatment.
Hemorrhage is a potential complication of Aquablation for benign prostatic hyperplasia (BPH). Severe bleeding may require intervention beyond conventional hemostatic measures.We report an 84-year-old male who developed massive hematuria post-Aquablation, leading to hemodynamic instability. Initial conservative measures failed, and angiography identified arterial extravasation. Due to recurrent bleeding, superselective transarterial embolization was performed twice, achieving hemostasis. The patient stabilized and was discharged on postoperative day 12 with improved urinary function.Transarterial embolization is an effective treatment for severe hemorrhage following Aquablation when standard hemostatic techniques fail.
