Harefuah
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Bronchoscopic techniques for the management of emphysema have evolved from the success of surgical treatment. Lung volume reduction surgery (LVRS) involves the removal of 20% to 30% of each lung and targets the most emphysematous segments. Patients with heterogeneous upper lobe emphysema and a low baseline exercise capacity have been identified as a subgroup within COPD in whom mortality benefits can even be achieved, along with improvements in exercise capacity and quality of life. ⋯ BLVR appears to be safer than LVRS in terms of mortality and morbidity. This safety profile presents an attractive alternative for patients with COPD who are fragile physiologically because of the severity of their lung disease and the presence of co-morbid illnesses. The current report aims to describe the various minimally invasive modalities available for the treatment of emphysema.
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Omalizumab is a humanized monoclonal anti-IgE for the treatment of moderate to severe allergic asthma. Although the treatment has been available for several years, there are some concerns about its safety and efficacy. ⋯ Data indicates that the high efficacy of add-on Omalizumab in patients with moderate to severe allergic asthma is accompanied by an acceptable safety profile.
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Head trauma represents a serious medical and socio-economical problem owing to its related morbidity and mortality. One of its serious complications is traumatic intracranial hemorrhage (TICH). There is evidence that TICH has a tendency to expand, especially during the first hours following injury. Aspirin has a central role in preventing thromboembolic complications in atherosclerotic conditions. This effect is mediated through the inhibition of platelet activity. There is a theoretical concern that treatment prior to the head injury with aspirin may expand the size of TICH. The purpose of the current study was to evaluate the effect of platelet transfusion on the extent of TICH expansion among patients treated with aspirin. ⋯ From this study it appears that platelet transfusion within 36 hours post injury for patients with TICH who were treated with aspirin prior to the head injury does not reduce the rate or extent of hemorrhagic expansion. However, owing to the limitations of the present study, this conclusion should be considered with caution. We recommend evaluating this issue in a prospective, randomized, multi-center study.
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Strikes in general represent a solution based on a form of coercion. Historically, the striker caused direct damage to his employer, who was responsible for the perceived unfair treatment of the employee. In the case of strikes in the public sector, the employer is generally not harmed, but innocent citizens suffer in order to pressure the government agencies, a questionable practice from an ethical viewpoint. ⋯ They cause suffering and death to innocent citizens. They violate the ethical codes to which physicians have committed themselves as professionals, and they seriously impair the trust of the public in physicians. Better and more ethical ways to provide fair compensation for physicians must be employed, perhaps like those used for judges and members of the IDF.
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In many European countries the use of opioids for long-term treatment of non-malignant pain has dramatically increased during the last decade in order to improve the patient's quality of life, to allow social activities and the return to work. Therefore, the issue of driving by patients regularly taking opioids, and its medico-legal aspects, concerns physicians, patients and society. ⋯ The decision to allow patients to drive under stable long-term opioid therapy is always individually based and should be founded on relevant and up-to-date clinical data, including both physical and mental evaluations. The patient, on the other hand, should also be responsible for his condition before and during driving.