Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare systemic small-vessel disease, with heterogeneous clinical manifestations. While arthralgia and myalgia are common in the disease course, frank myositis is exceedingly rare. Immune-mediated necrotizing myopathy (IMNM) is a subtype of idiopathic inflammatory myopathies (IIMs), characterized by severe myositis. We report herein a case of prominent diffuse myositis with shared features of AAV and IMNM.
Background and Objective: Medical cannabis is becoming an acceptable treatment modality in medicine, especially for pain relief. Concurrently, cannabis use is becoming more prevalent worldwide, a public demand-driven trend despite the lack of established scientific basis. This observational open-label study sought to investigate the effectiveness of cannabis therapy for alleviating low back pain symptoms.
Methods: Two types of cannabis treatment modalities were sequentially administered to chronic low back pain patients. After an initial 1-month washout period (WO1), the first modality was cannabidiol (CBD)-rich sublingual extract treatment administered for 10 months. Following another washout period, the second modality, Δ⁹-tetrahydrocannabinol (THC)-rich smoked inflorescence (whole dried cannabis flowers) was administered for 12 months.
Results: Enrolled in the study were 24 patients whose advanced imaging studies (i.e. computerized tomography or magnetic resonance imaging of the lumbar spine) revealed disc herniation or spinal stenosis. Three patients dropped out of extract therapy treatment but resumed study participation to receive THC-rich smoking therapy. After a minimum of 2 years, cannabis therapy had reduced lower back pain symptoms, as assessed by Oswestry Disability Index, the SF-12 patient-reported outcome questionnaire, and the visual analogue scale. Pain reduction was not significant during the extract treatment part of the study; however, pain reduction was significant during the inhaled therapy part of the study.
Conclusions: Our findings indicate that inhaled THC-rich therapy is more effective than CBD-rich sublingual extract therapy for treating low back pain and that cannabis therapy is safe and effective for chronic low back pain.
Introduction: The second wave of coronavirus disease 2019 (COVID-19) led to the resurgence of opportunistic infections due to the injudicious use of steroids. Sinonasal mucormycosis was declared an epidemic in India during the pandemic. Mucormycosis was managed effectively by surgical debridement along with systemic amphotericin B. Currently, a resurgence of mucormycosis following initial treatment, in the form of fungal osteomyelitis of the frontal bone, is being seen in India.
Methods: This prospective study included 10 patients with fungal osteomyelitis of the frontal bone due to mucormycosis. All patients underwent surgical debridement of the sequestrum and involucrum, with systemic antifungal pharmacotherapy.
Results: The average duration of time until mucormycosis recurrence was 22 days following initial treatment (range 10–33 days). Patients presented with extracranial bossing following outer frontal cortex erosion (n=3), bicortical erosion (n=3), bifrontal involvement (n=2), dural involvement (n=3), and involvement of the brain parenchyma and prefrontal cortex (n=2). All cases underwent debridement of the entire sequestrous bone and involucrum until normal bone could be identified. The mean admission duration was 4 weeks (range 3–6 weeks). All treated patients are currently alive and without disease, confirmed by contrast-enhanced computed tomography.
Conclusion: Based on our experience, the successful treatment of fungal osteomyelitis due to mucormycosis requires a four-pronged approach: early detection, multidisciplinary management of comorbidities, surgical debridement of necrotic bone, and adequate systemic antifungal therapy.
Clustered regularly interspaced short palindromic repeats (CRISPR) gene editing is an innovative and potentially game-changing biotechnology that can potentially reverse DNA mutations in a tissue-specific manner. In addition, CRISPR is being targeted for xenotransplantation, for increasing human longevity, in animal breeding, and in plant science. However, there are many ethical challenges that emerge from CRISPR technology. This article discusses several positions that relate to these ethical challenges from a Jewish legal perspective. In addition, we present several other applications of CRISPR technology that lack a defined Jewish legal precedent and require rabbinical scholars to address and resolve them in the future.
Purpose: This case series analyzed the appropriateness of computed tomography (CT) and magnetic resonance imaging (MRI) for visualization of rhinoorbitocerebral mucormycosis (ROCM) patterns associated with type 2 diabetes (T2D) post-recovery from coronavirus disease 2019 (COVID-19).
Methods: The study included 24 patients with invasive ROCM after having recovered from COVID-19. All patients underwent CT examinations and microbiological and histological verification; 5 patients underwent MRI.
Results: The CT and MRI patterns noted in our patients revealed involvement of skull orbits, paranasal sinuses, large arteries, and optic nerves, with intracranial spread and involvement of the cranial base bones. Using brain scan protocol for CT provided better soft-tissue resolution. We found that extending the MRI protocol by T2-sequence with fat suppression or STIR was better for periantral fat and muscle evaluations.
Conclusion: Computed tomography of the paranasal sinuses is the method of choice for suspected fungal infections, particularly mucormycosis. However, MRI is recommended if there is suspicion of orbital, vascular, or intracranial complications, including cavernous sinus extension. The combination of both CT and MRI enables determination of soft tissue invasion and bony destruction, thereby facilitating the choice of an optimal ROCM treatment strategy. Invasive fungal infections are extremely rare in Europe; most of the related data are provided from India and Middle Eastern or African nations. Hence, this study is notable in its use of only diagnosed ROCM cases in Russia.
Background: The Circassian community in Israel represents a unique, endogamous population residing in two villages in the northern region of Israel: Kfar Kama (209 meters above sea level [m.a.s.l.]) and Rihaniya (674 m.a.s.l.).
Objectives: This study sought to investigate whether the small difference in altitude between these two locations (465 m) affects red blood cell (RBC) and hemoglobin (Hb) parameters in the residents.
Methods: We examined the data from 2,517 blood samples collected from adult Israeli Circassians over 2.5 years (January 2020–June 2022). To ensure independent observations, analysis was limited to each participant’s most recent complete blood count (CBC). Subjects were stratified by sex, age, anemia status, and residential location.
Results: Our analysis revealed that a difference of about 465 meters in residential altitude significantly elevated Hb, RBC count, and hematocrit (HCT) levels in non-anemic male and female cohorts. This elevation was accompanied by a small but significant decrease in mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH). Furthermore, we found that the effect of altitude on most RBC characteristics differed in anemic individuals of both sexes, although their RBC count still increased.
Conclusions: Even minor differences in residential altitude can significantly influence Hb and RBC parameters. This observation appears only in non-anemic individuals, probably reflecting physiological altitude Hb adaptation mechanisms. While further research is needed to fully elucidate the underlying mechanisms, our findings provide new data on the physiological impact of altitude on human health, particularly at low altitudes.
Background: Chronic hypoxemia in patients with COPD is associated with increased morbidity and mortality. Although arterial partial pressure of oxygen (PaO2) is widely used, it does not adequately reflect systemic oxygen transport. Arterial oxygen content (CaO2) may provide a more comprehensive assessment.
Objective: This study aimed to evaluate whether or not CaO2 is a better predictor of mortality than PaO2 in patients with COPD.
Methods: This retrospective observational cohort study included 147 COPD patients aged ≥45 years. Patients were categorized according to CaO2 levels (low, normal, high). Mortality at 1, 3, and 5 years was analyzed. Statistical methods included ROC curves, Kaplan–Meier survival analysis, and Cox regression models.
Results: A total of 66 deaths (45.2%) occurred in the study cohort. Mortality was highest in the low CaO2 group. The CaO2 demonstrated better predictive performance than PaO2 (AUC 0.73 vs 0.53, respectively). Low CaO2 was associated with a 2.5-fold increased risk of mortality. Despite improvements in PaO2 after long-term oxygen therapy, CaO2 did not significantly change.
Conclusions: The CaO2 is a more informative marker of oxygen transport and mortality risk than PaO2 in COPD patients. It should be considered a complementary parameter in clinical assessment.
Background: The International Association for the Study of Pain (IASP) has defined three mechanisms for chronic pain: nociceptive, neuropathic, and nociplastic. Accurate differentiation between these mechanisms is essential for treatment selection but remains challenging due to symptom overlap and reliance on clinical judgment. Patient-reported questionnaires may support diagnosis, though their diagnostic accuracy relative to physician assessment has not been fully established.
Objectives: This study aimed to investigate the prevalence and overlap of chronic pain mechanisms in a tertiary pain clinic population and to compare physician-assigned diagnoses with results from patient-reported questionnaires.
Methods: This cross-sectional study recruited 89 adult patients with chronic pain from the Rambam Institute for Pain Medicine at Rambam Health Care Campus in Haifa, Israel. Each participant underwent a comprehensive physician evaluation based on the criteria of the International Classification of Diseases and Related Health Problems, 11th revision, and completed the Central Sensitization Inventory (CSI), PainDETECT, and 2016 American College of Rheumatology (ACR) Fibromyalgia Diagnostic Criteria surveys. Diagnostic agreement, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using physician diagnosis as the reference standard.
Results: Physician diagnoses identified neuropathic pain in 51 patients (57.3%), nociceptive pain in 38 (42.7%), and nociplastic pain in 25 (28.1%), with substantial diagnostic overlap (32.6% with ≥2 mechanisms). The CSI demonstrated high sensitivity (92.0%) but low specificity (45.3%) for nociplastic pain. PainDETECT showed moderate accuracy for neuropathic pain (sensitivity 68.6%, specificity 52.6%) and higher specificity for nociceptive pain (86.3%). The 2016 ACR Fibromyalgia criteria provided a more balanced diagnostic profile (sensitivity 88.0%, specificity 68.8%).
Conclusions: Questionnaire-based measures are useful for screening chronic pain mechanisms but demonstrate variable accuracy when compared to physician diagnoses, particularly in the context of overlapping pain phenotypes. Refinement of diagnostic thresholds, combined assessment strategies, and updated questionnaires may improve differentiation of pain subtypes and enhance clinical decision-making.
Mifepristone (RU-486), the first clinically effective progesterone antagonist, was initially identified as having antiglucocorticoid activity. Although early interest focused on its role as a glucocorticoid receptor antagonist, recognition of its antiprogesterone effects led to studies of its role in pregnancy termination. This article reviews the steps leading to its use as an abortifacient, from its initial identification for this indication and draws on the author’s direct involvement in the field with reflections on his contribution to the early clinical development of mifepristone. These studies established the efficacy of mifepristone in pregnancy termination. Unfortunately, its wider therapeutic applications have received limited attention.
Background: Sleep disturbances, particularly insomnia, are increasingly recognized as behavioral determinants of type 2 diabetes (T2DM). However, their contribution to validated diabetes risk scores beyond traditional sociodemographic and lifestyle factors remains insufficiently explored.
Objective: To examine the association between insomnia severity, sociodemographic variables, lifestyle habits, and estimated T2DM risk using three validated non-invasive risk assessment scales.
Methods: A cross-sectional study was conducted among 84,898 Spanish workers aged 18–69 years undergoing occupational health evaluations (2021–2024). Sociodemographic and behavioral data were collected through standardized questionnaires, including adherence to the Mediterranean diet (MEDAS-14), physical activity (IPAQ-SF), and smoking status. Insomnia was assessed using the Insomnia Severity Index (ISI). Diabetes risk was estimated using three validated non-invasive risk-assessment tools: the Finnish Diabetes Risk Score, the QDScore/QDiabetes, and the Trinidad Risk Assessment Questionnaire for Type 2 Diabetes Mellitus. As these instruments were developed and validated in different populations, comparisons of absolute risk categories across scales should be interpreted with caution. Multivariable logistic regression models adjusted for age, sex, social class, smoking, diet, and physical activity were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).
Results: Severe insomnia was associated with approximately 2.1–2.6-fold higher odds of high estimated diabetes risk across all three scales in the pooled analyses, with significant trends across categories of insomnia severity (all P for trend <0.001). This association persisted across sex and activity strata. Adding ISI modestly improved model discrimination (ΔAUC ≈ +0.015; P≤0.003) and reclassification (continuous net reclassification improvement [NRI], 6.5%–8.1%).
Conclusions: Insomnia severity was independently associated with higher estimated risk of T2DM beyond measured sociodemographic and lifestyle determinants. Incorporating sleep health—via brief tools such as the ISI—into diabetes risk assessment could enhance early prevention strategies in clinical and occupational settings.
