Miklosh Bala - Academia.edu (original) (raw)

Papers by Miklosh Bala

World Journal of Surgery

Background International register of open abdomen (IROA) enrolls patients from several centers in... more Background International register of open abdomen (IROA) enrolls patients from several centers in American, European, and Asiatic continent. The aim of our study is to compare the characteristics, management and clinical outcome of adult patients treated with OA in the three continents. Material and methods A prospective analysis of adult patients enrolled in the international register of open abdomen (IROA). Trial registration: NCT02382770. Results 1183 patients were enrolled from American, European and Asiatic Continent. Median age was 63 years (IQR 49–74) and was higher in the European continent (65 years, p < 0.001); 57% were male. The main indication for OA was peritonitis (50.6%) followed by trauma (15.4%) and vascular emergency (13.5%) with differences among the continents (p < 0.001). Commercial NPWT was preferred in America and Europe (77.4% and 52.3% of cases) while Barker vacuum pack (48.2%) was the preferred temporary abdominal closure technique in Asia (p < 0.0...

Journal of the American Medical Directors Association, 2022

OBJECTIVES Describe the epidemiology of a large cohort of older adults with isolated traumatic br... more OBJECTIVES Describe the epidemiology of a large cohort of older adults with isolated traumatic brain injury (TBI) and identify predictors of mortality, palliative interventions, and discharge to preinjury residence in those presenting with moderate/severe TBI. DESIGN Prospective observational study of geriatric patients with TBI enrolled across 45 trauma centers. SETTING AND PARTICIPANTS Inclusion criteria were age ≥40 years, and computed tomography (CT)-verified TBI. Exclusion criteria were any other body region abbreviated injury scale score >2 and presentation at enrolling center >24 hours after injury. METHODS The analysis was restricted to individuals aged ≥65 and stratified into 3 age groups: young-old (65-74), middle-old (75-84), and oldest-old (≥85). Demographic, clinical, and injury data were collected. Predictors of mortality, palliative interventions, and discharge to preinjury residence in the moderate/severe TBI group were identified using Classification and Regression Tree and Generalized Linear Mixed Models. RESULTS Of the 3081 subjects enrolled in the study, 2028 were ≥65 years old. Overall, 339 (16.7%) presented with a moderate/severe TBI and experienced a 64% mortality rate. A Glasgow Coma Scale (GCS) score <9 was the main predictor of mortality, CT worsening (odds ratio [OR] = 1.7, P < .04), cerebral edema (OR = 2.4, P < .04), GCS <9, and age ≥75 (OR = 2.1, P = .007) were predictors for palliative interventions, and an injury severity score ≤24 (OR = 0.087, P = .002) was associated with increased likelihood of discharge to preinjury residence in the moderate/severe TBI group. CONCLUSION AND IMPLICATIONS In this prospective study of a large cohort of older adults with isolated TBI, comparisons across the older age groups with moderate/severe TBI revealed that survival and favorable discharge disposition were influenced more by severity of injury rather than age itself. Indicating that chronological age alone maybe insufficient to accurately predict outcomes, and increased representation of older adults in TBI research to develop better diagnostic and prognostic tools is warranted.

Complications of high grade liver injuries: management and outcomewith focus on bile leaks

Disaster Medicine and Public Health Preparedness, 2021

The importance of MCI organization and training was highlighted by the events of September 11, 20... more The importance of MCI organization and training was highlighted by the events of September 11, 2001. Training focuses on the management of physical injuries caused by a single traumatic event over a well-defined, relatively short timeframe. MCI management is integrated into surgical and trauma training, with disaster management training involving the emergency services, law enforcement, and state infrastructure agencies. The COVID-19 pandemic revealed gaps in the preparedness of nation states and global partners in disaster management. The questions that arose include ‘has training really prepared us for an actual emergency,’ ‘what changes need to be made to training to make it more effective,’ and ‘who else should training be extended to?’ This article focuses on the importance of involving multiple sectors in mass casualty training and asks whether greater involvement of non-medical agencies and the public, in operational drills might improve preparedness for global events such as...

Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2020

The remarks made by Kow and Hasan 1 regarding the use of low-molecular-weight heparin (LMWH) in h... more The remarks made by Kow and Hasan 1 regarding the use of low-molecular-weight heparin (LMWH) in hospitalized COVID-19 patients are greatly appreciated since they focus on one of the most important aspects concerning the treatment of this disease, namely, thromboprophylaxis. In fact, since our latest letter was published in this Journal, suggesting a close correlation between COVID-19 and deep venous thrombosis (DVT), 2 a number of studies have followed, confirming this view and providing evidence of the fact that respiratory infection is also responsible for a systemic procoagulant activity, 3-5 which can lead to different clinical manifestations ranging from DVT to septic intravascular coagulation, not only in the most critical cases (patients in intensive care unit) but in all in-hospital patients. In light of this evidence, heparin has become a cornerstone of the treatment against COVID-19, along with empirical antiviral and antibiotic therapy, but the correct dose to administer is still the subject of discussion. 6 Most centers continue to administer a prophylactic dose of LMWH (100 mUI/kg daily), although our experience reports several cases of DVT and pulmonary embolism in COVID-19 patients with this posology, which justifies the use of anticoagulant doses (100 mUI/kg twice a day) when no absolute contraindication to anticoagulant therapy exists. This is, in our opinion, a correct approach, although there are other potential risks to be taken into account, for example, thrombocytopenia, a common alteration in COVID-19 patients that is a predictor of poor prognosis and can be worsened by LMWH. 7 The decision is, in fact, a difficult one, and it is made even harder by the many things that we still ignore regarding the effects that the virus has on the hemostatic function. In this respect, constant and careful monitoring of platelet count and coagulation parameters (especially D-dimer and fibrinogen) throughout the entire clinical course is crucial to recognize and minimize complications. In conclusion, we share the authors' view that COVID-19 is a powerful risk factor for DVT; moreover, in hospitalized patients, it is often associated with pre-existing comorbidities (advanced age, obesity) and immobilization that further enhance the thrombotic risk, and so all measures should be adopted to counteract the onset of DVT or other clinical manifestations of an altered hemostasis. To this purpose, further studies investigating the relationship between disease severity and the extent of coagulopathy will be necessary to select those patients who need more protection.

World journal of emergency surgery : WJES, 2015

To validate a new practical Sepsis Severity Score for patients with complicated intra-abdominal i... more To validate a new practical Sepsis Severity Score for patients with complicated intra-abdominal infections (cIAIs) including the clinical conditions at the admission (severe sepsis/septic shock), the origin of the cIAIs, the delay in source control, the setting of acquisition and any risk factors such as age and immunosuppression. The WISS study (WSES cIAIs Score Study) is a multicenter observational study underwent in 132 medical institutions worldwide during a four-month study period (October 2014-February 2015). Four thousand five hundred thirty-three patients with a mean age of 51.2 years (range 18-99) were enrolled in the WISS study. Univariate analysis has shown that all factors that were previously included in the WSES Sepsis Severity Score were highly statistically significant between those who died and those who survived…

World Journal of Emergency Surgery, 2015

In the last two decades there have been dramatic changes in the epidemiology of Clostridium diffi... more In the last two decades there have been dramatic changes in the epidemiology of Clostridium difficile infection (CDI), with increases in incidence and severity of disease in many countries worldwide. The incidence of CDI has also increased in surgical patients. Optimization of management of C difficile, has therefore become increasingly urgent. An international multidisciplinary panel of experts prepared evidenced-based World Society of Emergency Surgery (WSES) guidelines for management of CDI in surgical patients.

World journal of emergency surgery : WJES, 2015

The open abdomen (OA) procedure is a significant surgical advance, as part of damage control tech... more The open abdomen (OA) procedure is a significant surgical advance, as part of damage control techniques in severe abdominal trauma. Its application can be adapted to the advantage of patients with severe abdominal sepsis, however its precise role in these patients is still not clear. In severe abdominal sepsis the OA may allow early identification and draining of any residual infection, control any persistent source of infection, and remove more effectively infected or cytokine-loaded peritoneal fluid, preventing abdominal compartment syndrome and deferring definitive intervention and anastomosis until the patient is appropriately resuscitated and hemodynamically stable and thus better able to heal. However, the OA may require multiple returns to the operating room and may be associated with significant complications, including enteroatmospheric fistulas, loss of abdominal wall domain and large hernias. Surgeons should be aware of the pathophysiology of severe intra-abdominal sepsis...

World journal of emergency surgery : WJES, Jan 8, 2013

Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated wit... more Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high.The 2013 update of the World Society of Emergency Surgery (WSES) guidelines for the management of intra-abdominal infections contains evidence-based recommendations for management of patients with intra-abdominal infections.

World journal of emergency surgery : WJES, 2014

Skin and soft tissue infections (SSTIs) encompass a variety of pathological conditions ranging fr... more Skin and soft tissue infections (SSTIs) encompass a variety of pathological conditions ranging from simple superficial infections to severe necrotizing soft tissue infections. Necrotizing soft tissue infections (NSTIs) are potentially life-threatening infections of any layer of the soft tissue compartment associated with widespread necrosis and systemic toxicity. Successful management of NSTIs involves prompt recognition, timely surgical debridement or drainage, resuscitation and appropriate antibiotic therapy. A worldwide international panel of experts developed evidence-based guidelines for management of soft tissue infections. The multifaceted nature of these infections has led to a collaboration among surgeons, intensive care and infectious diseases specialists, who have shared these guidelines, implementing clinical practice recommendations.

The Journal of Trauma: Injury, Infection, and Critical Care, 2007

ABSTRACT Over the past few decades, surgical management of blunt abdominal trauma has shifted fro... more ABSTRACT Over the past few decades, surgical management of blunt abdominal trauma has shifted from operative to selective nonoperative. This trend to nonoperative management was driven by the fact that in 30% of laparotomies following blunt abdominal trauma, no intraabdominal procedure was carried out.(1) Nonoperative management of blunt liver and splenic injuries is accepted 2 and eliminates complications associated with nontherapeutic laparotomies. However, any benefit of selective nonoperative management should be weighted against the consequences of missed injuries and delayed diagnosis. We present a case of blunt abdominal trauma that was treated nonoperatively. Despite the success of initial treatment, the patient suffered from recurrent abdominal pain during the following year and underwent two abdominal operations.

Surgeries, 2022

Background: The aim of this study was to describe the impact of a COVID-19 lockdown on the variat... more Background: The aim of this study was to describe the impact of a COVID-19 lockdown on the variation in the volumes and types of injuries at a level one trauma center while focusing on preserving trauma care resources. Methods: A retrospective, descriptive study of prospectively collected data from the Trauma Registry. Data collection included patient demographics, injury mechanism, injury type and treatment required. The time periods studied corresponded with the lockdown period in Israel and a parallel period in 2019. Results: Overall, there was no reduction in all injury-related admissions. There was a significant reduction in pedestrian injuries (p < 0.02) and a non-significant increase in children admissions aged 0–2 years. Compared to the previous years, the severity of injuries during the March–April 2020 lockdown was unchanged. Hospital resources (number and percentage of trauma patients who required an operation, ICU stay and LOS) were not different between the lockdown ...

Intensive Care for Emergency Surgeons, 2020

Additional file 1. Appendix 1. List of participants.

Colonic bezoars as a cause of obstruction have not been widely described in the literature, so no... more Colonic bezoars as a cause of obstruction have not been widely described in the literature, so no conclusions can be drawn based on available data. We present a case of large bowel obstruction in an adult blind patient caused by a colonic mass suspicious for tumor or bezoar by its radiological features. Colonic bezoar should be suspected when large bowel obstruction takes place in older patients with chronic constipation or a disability in controling food intake. There are no specific diagnostic findings related to colonic bezoars, but computerized tomography seems to be the most readily available to characterize bezoar in this case. CT diagnosis of bezoar was based on identifying a low-density intraluminal mass containing air bubbles and exhibiting a characteristic mottled appearance. The treatment may vary depending on the clinical situation. If diagnosis is correctly made, surgical operation can be averted. Early and effective management of constipation could help prevent this condition.

World Journal of Emergency Surgery : WJES, 2021

Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postopera... more Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life. BDIs have an estimated incidence of 0.4–1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success. Subsequently, the choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis. Currently, a wide spectrum of multidisciplinary interventions with different degrees of inva...

Drugs, 2021

Severe intra-abdominal infection commonly requires intensive care. Mortality is high and is mainl... more Severe intra-abdominal infection commonly requires intensive care. Mortality is high and is mainly determined by disease-specific characteristics, i.e. setting of infection onset, anatomical barrier disruption, and severity of disease expression. Recent observations revealed that antimicrobial resistance appears equally common in community-acquired and late-onset hospital-acquired infection. This challenges basic principles in anti-infective therapy guidelines, including the paradigm that pathogens involved in community-acquired infection are covered by standard empiric antimicrobial regimens, and second, the concept of nosocomial acquisition as the main driver for resistance involvement. In this study, we report on resistance profiles of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis and Enterococcus faecium in distinct European geographic regions based on an observational cohort study on intra-abdominal infections in intensive care unit (ICU...

OTA International, 2021

South Africa and Israel have significantly different health systems. As South Africa is geographi... more South Africa and Israel have significantly different health systems. As South Africa is geographically 500 times as large and has a population nearly 7 times as large as the state of Israel, major differences in the challenges and subsequent handling of the pandemic between these countries were to be expected. South Africa's challenges included being under-resourced, particularly related to trauma, and severe and radical measures had to be undertaken that included extended strict lockdowns, bans on alcohol sales, and cancellation of the majority of the elective surgery during this initial period of the pandemic. Although Israel is much smaller and thereby theoretically easier to control, a complex political situation created difficulties and delays in controlling the pandemic after the initial response, leading to a second wave and additional lockdown. Although massively engaged initially, the Israeli trauma systems had continued functioning almost normally throughout the COVID-...

World Journal of Surgery

Background International register of open abdomen (IROA) enrolls patients from several centers in... more Background International register of open abdomen (IROA) enrolls patients from several centers in American, European, and Asiatic continent. The aim of our study is to compare the characteristics, management and clinical outcome of adult patients treated with OA in the three continents. Material and methods A prospective analysis of adult patients enrolled in the international register of open abdomen (IROA). Trial registration: NCT02382770. Results 1183 patients were enrolled from American, European and Asiatic Continent. Median age was 63 years (IQR 49–74) and was higher in the European continent (65 years, p < 0.001); 57% were male. The main indication for OA was peritonitis (50.6%) followed by trauma (15.4%) and vascular emergency (13.5%) with differences among the continents (p < 0.001). Commercial NPWT was preferred in America and Europe (77.4% and 52.3% of cases) while Barker vacuum pack (48.2%) was the preferred temporary abdominal closure technique in Asia (p < 0.0...

Journal of the American Medical Directors Association, 2022

OBJECTIVES Describe the epidemiology of a large cohort of older adults with isolated traumatic br... more OBJECTIVES Describe the epidemiology of a large cohort of older adults with isolated traumatic brain injury (TBI) and identify predictors of mortality, palliative interventions, and discharge to preinjury residence in those presenting with moderate/severe TBI. DESIGN Prospective observational study of geriatric patients with TBI enrolled across 45 trauma centers. SETTING AND PARTICIPANTS Inclusion criteria were age ≥40 years, and computed tomography (CT)-verified TBI. Exclusion criteria were any other body region abbreviated injury scale score >2 and presentation at enrolling center >24 hours after injury. METHODS The analysis was restricted to individuals aged ≥65 and stratified into 3 age groups: young-old (65-74), middle-old (75-84), and oldest-old (≥85). Demographic, clinical, and injury data were collected. Predictors of mortality, palliative interventions, and discharge to preinjury residence in the moderate/severe TBI group were identified using Classification and Regression Tree and Generalized Linear Mixed Models. RESULTS Of the 3081 subjects enrolled in the study, 2028 were ≥65 years old. Overall, 339 (16.7%) presented with a moderate/severe TBI and experienced a 64% mortality rate. A Glasgow Coma Scale (GCS) score <9 was the main predictor of mortality, CT worsening (odds ratio [OR] = 1.7, P < .04), cerebral edema (OR = 2.4, P < .04), GCS <9, and age ≥75 (OR = 2.1, P = .007) were predictors for palliative interventions, and an injury severity score ≤24 (OR = 0.087, P = .002) was associated with increased likelihood of discharge to preinjury residence in the moderate/severe TBI group. CONCLUSION AND IMPLICATIONS In this prospective study of a large cohort of older adults with isolated TBI, comparisons across the older age groups with moderate/severe TBI revealed that survival and favorable discharge disposition were influenced more by severity of injury rather than age itself. Indicating that chronological age alone maybe insufficient to accurately predict outcomes, and increased representation of older adults in TBI research to develop better diagnostic and prognostic tools is warranted.

Complications of high grade liver injuries: management and outcomewith focus on bile leaks

Disaster Medicine and Public Health Preparedness, 2021

The importance of MCI organization and training was highlighted by the events of September 11, 20... more The importance of MCI organization and training was highlighted by the events of September 11, 2001. Training focuses on the management of physical injuries caused by a single traumatic event over a well-defined, relatively short timeframe. MCI management is integrated into surgical and trauma training, with disaster management training involving the emergency services, law enforcement, and state infrastructure agencies. The COVID-19 pandemic revealed gaps in the preparedness of nation states and global partners in disaster management. The questions that arose include ‘has training really prepared us for an actual emergency,’ ‘what changes need to be made to training to make it more effective,’ and ‘who else should training be extended to?’ This article focuses on the importance of involving multiple sectors in mass casualty training and asks whether greater involvement of non-medical agencies and the public, in operational drills might improve preparedness for global events such as...

Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2020

The remarks made by Kow and Hasan 1 regarding the use of low-molecular-weight heparin (LMWH) in h... more The remarks made by Kow and Hasan 1 regarding the use of low-molecular-weight heparin (LMWH) in hospitalized COVID-19 patients are greatly appreciated since they focus on one of the most important aspects concerning the treatment of this disease, namely, thromboprophylaxis. In fact, since our latest letter was published in this Journal, suggesting a close correlation between COVID-19 and deep venous thrombosis (DVT), 2 a number of studies have followed, confirming this view and providing evidence of the fact that respiratory infection is also responsible for a systemic procoagulant activity, 3-5 which can lead to different clinical manifestations ranging from DVT to septic intravascular coagulation, not only in the most critical cases (patients in intensive care unit) but in all in-hospital patients. In light of this evidence, heparin has become a cornerstone of the treatment against COVID-19, along with empirical antiviral and antibiotic therapy, but the correct dose to administer is still the subject of discussion. 6 Most centers continue to administer a prophylactic dose of LMWH (100 mUI/kg daily), although our experience reports several cases of DVT and pulmonary embolism in COVID-19 patients with this posology, which justifies the use of anticoagulant doses (100 mUI/kg twice a day) when no absolute contraindication to anticoagulant therapy exists. This is, in our opinion, a correct approach, although there are other potential risks to be taken into account, for example, thrombocytopenia, a common alteration in COVID-19 patients that is a predictor of poor prognosis and can be worsened by LMWH. 7 The decision is, in fact, a difficult one, and it is made even harder by the many things that we still ignore regarding the effects that the virus has on the hemostatic function. In this respect, constant and careful monitoring of platelet count and coagulation parameters (especially D-dimer and fibrinogen) throughout the entire clinical course is crucial to recognize and minimize complications. In conclusion, we share the authors' view that COVID-19 is a powerful risk factor for DVT; moreover, in hospitalized patients, it is often associated with pre-existing comorbidities (advanced age, obesity) and immobilization that further enhance the thrombotic risk, and so all measures should be adopted to counteract the onset of DVT or other clinical manifestations of an altered hemostasis. To this purpose, further studies investigating the relationship between disease severity and the extent of coagulopathy will be necessary to select those patients who need more protection.

World journal of emergency surgery : WJES, 2015

To validate a new practical Sepsis Severity Score for patients with complicated intra-abdominal i... more To validate a new practical Sepsis Severity Score for patients with complicated intra-abdominal infections (cIAIs) including the clinical conditions at the admission (severe sepsis/septic shock), the origin of the cIAIs, the delay in source control, the setting of acquisition and any risk factors such as age and immunosuppression. The WISS study (WSES cIAIs Score Study) is a multicenter observational study underwent in 132 medical institutions worldwide during a four-month study period (October 2014-February 2015). Four thousand five hundred thirty-three patients with a mean age of 51.2 years (range 18-99) were enrolled in the WISS study. Univariate analysis has shown that all factors that were previously included in the WSES Sepsis Severity Score were highly statistically significant between those who died and those who survived…

World Journal of Emergency Surgery, 2015

In the last two decades there have been dramatic changes in the epidemiology of Clostridium diffi... more In the last two decades there have been dramatic changes in the epidemiology of Clostridium difficile infection (CDI), with increases in incidence and severity of disease in many countries worldwide. The incidence of CDI has also increased in surgical patients. Optimization of management of C difficile, has therefore become increasingly urgent. An international multidisciplinary panel of experts prepared evidenced-based World Society of Emergency Surgery (WSES) guidelines for management of CDI in surgical patients.

World journal of emergency surgery : WJES, 2015

The open abdomen (OA) procedure is a significant surgical advance, as part of damage control tech... more The open abdomen (OA) procedure is a significant surgical advance, as part of damage control techniques in severe abdominal trauma. Its application can be adapted to the advantage of patients with severe abdominal sepsis, however its precise role in these patients is still not clear. In severe abdominal sepsis the OA may allow early identification and draining of any residual infection, control any persistent source of infection, and remove more effectively infected or cytokine-loaded peritoneal fluid, preventing abdominal compartment syndrome and deferring definitive intervention and anastomosis until the patient is appropriately resuscitated and hemodynamically stable and thus better able to heal. However, the OA may require multiple returns to the operating room and may be associated with significant complications, including enteroatmospheric fistulas, loss of abdominal wall domain and large hernias. Surgeons should be aware of the pathophysiology of severe intra-abdominal sepsis...

World journal of emergency surgery : WJES, Jan 8, 2013

Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated wit... more Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high.The 2013 update of the World Society of Emergency Surgery (WSES) guidelines for the management of intra-abdominal infections contains evidence-based recommendations for management of patients with intra-abdominal infections.

World journal of emergency surgery : WJES, 2014

Skin and soft tissue infections (SSTIs) encompass a variety of pathological conditions ranging fr... more Skin and soft tissue infections (SSTIs) encompass a variety of pathological conditions ranging from simple superficial infections to severe necrotizing soft tissue infections. Necrotizing soft tissue infections (NSTIs) are potentially life-threatening infections of any layer of the soft tissue compartment associated with widespread necrosis and systemic toxicity. Successful management of NSTIs involves prompt recognition, timely surgical debridement or drainage, resuscitation and appropriate antibiotic therapy. A worldwide international panel of experts developed evidence-based guidelines for management of soft tissue infections. The multifaceted nature of these infections has led to a collaboration among surgeons, intensive care and infectious diseases specialists, who have shared these guidelines, implementing clinical practice recommendations.

The Journal of Trauma: Injury, Infection, and Critical Care, 2007

ABSTRACT Over the past few decades, surgical management of blunt abdominal trauma has shifted fro... more ABSTRACT Over the past few decades, surgical management of blunt abdominal trauma has shifted from operative to selective nonoperative. This trend to nonoperative management was driven by the fact that in 30% of laparotomies following blunt abdominal trauma, no intraabdominal procedure was carried out.(1) Nonoperative management of blunt liver and splenic injuries is accepted 2 and eliminates complications associated with nontherapeutic laparotomies. However, any benefit of selective nonoperative management should be weighted against the consequences of missed injuries and delayed diagnosis. We present a case of blunt abdominal trauma that was treated nonoperatively. Despite the success of initial treatment, the patient suffered from recurrent abdominal pain during the following year and underwent two abdominal operations.

Surgeries, 2022

Background: The aim of this study was to describe the impact of a COVID-19 lockdown on the variat... more Background: The aim of this study was to describe the impact of a COVID-19 lockdown on the variation in the volumes and types of injuries at a level one trauma center while focusing on preserving trauma care resources. Methods: A retrospective, descriptive study of prospectively collected data from the Trauma Registry. Data collection included patient demographics, injury mechanism, injury type and treatment required. The time periods studied corresponded with the lockdown period in Israel and a parallel period in 2019. Results: Overall, there was no reduction in all injury-related admissions. There was a significant reduction in pedestrian injuries (p < 0.02) and a non-significant increase in children admissions aged 0–2 years. Compared to the previous years, the severity of injuries during the March–April 2020 lockdown was unchanged. Hospital resources (number and percentage of trauma patients who required an operation, ICU stay and LOS) were not different between the lockdown ...

Intensive Care for Emergency Surgeons, 2020

Additional file 1. Appendix 1. List of participants.

Colonic bezoars as a cause of obstruction have not been widely described in the literature, so no... more Colonic bezoars as a cause of obstruction have not been widely described in the literature, so no conclusions can be drawn based on available data. We present a case of large bowel obstruction in an adult blind patient caused by a colonic mass suspicious for tumor or bezoar by its radiological features. Colonic bezoar should be suspected when large bowel obstruction takes place in older patients with chronic constipation or a disability in controling food intake. There are no specific diagnostic findings related to colonic bezoars, but computerized tomography seems to be the most readily available to characterize bezoar in this case. CT diagnosis of bezoar was based on identifying a low-density intraluminal mass containing air bubbles and exhibiting a characteristic mottled appearance. The treatment may vary depending on the clinical situation. If diagnosis is correctly made, surgical operation can be averted. Early and effective management of constipation could help prevent this condition.

World Journal of Emergency Surgery : WJES, 2021

Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postopera... more Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life. BDIs have an estimated incidence of 0.4–1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success. Subsequently, the choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis. Currently, a wide spectrum of multidisciplinary interventions with different degrees of inva...

Drugs, 2021

Severe intra-abdominal infection commonly requires intensive care. Mortality is high and is mainl... more Severe intra-abdominal infection commonly requires intensive care. Mortality is high and is mainly determined by disease-specific characteristics, i.e. setting of infection onset, anatomical barrier disruption, and severity of disease expression. Recent observations revealed that antimicrobial resistance appears equally common in community-acquired and late-onset hospital-acquired infection. This challenges basic principles in anti-infective therapy guidelines, including the paradigm that pathogens involved in community-acquired infection are covered by standard empiric antimicrobial regimens, and second, the concept of nosocomial acquisition as the main driver for resistance involvement. In this study, we report on resistance profiles of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis and Enterococcus faecium in distinct European geographic regions based on an observational cohort study on intra-abdominal infections in intensive care unit (ICU...

OTA International, 2021

South Africa and Israel have significantly different health systems. As South Africa is geographi... more South Africa and Israel have significantly different health systems. As South Africa is geographically 500 times as large and has a population nearly 7 times as large as the state of Israel, major differences in the challenges and subsequent handling of the pandemic between these countries were to be expected. South Africa's challenges included being under-resourced, particularly related to trauma, and severe and radical measures had to be undertaken that included extended strict lockdowns, bans on alcohol sales, and cancellation of the majority of the elective surgery during this initial period of the pandemic. Although Israel is much smaller and thereby theoretically easier to control, a complex political situation created difficulties and delays in controlling the pandemic after the initial response, leading to a second wave and additional lockdown. Although massively engaged initially, the Israeli trauma systems had continued functioning almost normally throughout the COVID-...