The medico-legal investigation of the El Aqsah Intifada.
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BACKGROUND: The majority (n = 445) of the Israeli and Palestinian fatal victims of the El Aqsah Intifada was examined at the National Center of Forensic Medicine in Tel Aviv. Analysis of the trauma sustained and the anthropologic profile of both the victims and the perpetrators elucidates the trends and contrasts them with the phenomenon in the past. OBJECTIVES: The purpose of the forensic investigation of mass casualty incidents is manifold: establishing the minimal number of individuals involved, identifying the victims and perpetrators, collecting material evidence, and determining the modus operandi. METHODS: The postmortem examination includes external description of the bodies and their injuries, photo-documentation, and sampling of tissues. Radiography, dental examination, and a ten-print card of each cadaver are also recorded. RESULTS: The modus operandi of the current Intifada is somewhat different from that of the previous wave of terrorism and includes more road shootings and vehicular terrorism. In addition, three suicide bombers who detonated explosive devices within crowded areas were young women, and the age of the perpetrators has increased from up to 35 years to individuals as old as 47, thus greatly enlarging the potential number of suicide terrorists. Virologic and biologic tests have been introduced to examine the tissues of the suicide bombers since they are possible sources of contagion to the wounded victims. CONCLUSION: The results of the medico-legal investigation of victims and perpetrators of terrorism enable us to establish the modus operandi and the profile of potential perpetrators, which can help in the prevention of similar attacks. Documentation of the different types of injuries in fatal victims of explosion and shooting contributes to improving the awareness of the medical staff treating the wounded of similar attacks. Further investigation into the reliability of virologic and biologic tests conducted on postmortem tissue is recommended. (+info)
The experience of one institution dealing with terror: the El Aqsa Intifada riots.
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BACKGROUND: During a period of 13 months--1 October 2000 to 31 October 2001--586 terror assault casualties were treated in the trauma unit and emergency department of Hadassah University Hospital (Ein Kerem campus); 27% (n = 158) were hospitalized and the rest were discharged within 24 hours. OBJECTIVES: To analyze the special requirements of a large number of victims who received treatment during a short period. METHODS: Data were attained from the main admitting office and the trauma registry records. Factors analyzed included age, gender, mechanism of injury, anatomic site of injury, Injury Severity Score, and length of stay. RESULTS: Males comprised 81% of the hospitalized patients. The majority of the injuries (70%) were due to gunshot wounds and 31% of the hospitalized patients were severely injured (ISS > or = 16). Twelve patients died, yielding a mortality rate of 7.5%. CONCLUSION: The nature of the injuries was more complex and severe than trauma of other etiologies, as noted by the mean length of stay (10.2 vs. 7.2 days), mean intensive care unit stay (2.8 vs. 0.9 days), and mean operations per patient (0.7 vs. 0.5). The mean insurance cost for each hospitalized terror casualty was also higher than for other trauma etiologies (US$ 3,200 vs. 2,500). (+info)
The role of radiology in terror injuries.
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Although one might think that nothing could be further apart than "terror" and "medicine," in reality, medicine is intimately involved in the rescuing of those who are injured in terrorist attacks and in identifying and determining the cause of death in those who do not survive. Radiology has an important role in the workup of trauma patients in general, and in patients injured during the course of a terrorist attack in particular. Radiologic examinations determine the location and severity of injuries and are used to follow injured patients, particularly when complications occur. Conventional X-rays and CT scans are useful to detect the presence of foreign bodies, such as bullets, shrapnel and nails, which are often combined with the explosive charge in suicide bombings. Both can also be used for postmortem examinations. Although biologic, chemical and radiologic warfare constitute a real threat for the future, it is essential that we be familiar with the more "conventional" forms of terror that we face today. (+info)
Fighting colorectal cancer: molecular epidemiology differences among Ashkenazi and Sephardic Jews and Palestinians.
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BACKGROUND: To evaluate and compare differences in the molecular genetics among high-risk (Ashkenazi Jews), intermediate-risk (Sephardic Jews) and low-risk (Palestinians) groups for colorectal cancer who live in the same geographical region. PATIENTS AND METHODS: The 1995-1996 records from the Tel Aviv Medical Center and Muqased hospital (East Jerusalem) randomly identified patients with colorectal cancer. There were 25 patients from each ethnic group. Epidemiological data were obtained from interviews with the patients and from their hospital charts. The levels of cyclin D1, beta-catenine, p27, p53, Ki-67 and Her-2/neu proteins were determined by immunohistochemistry. The main outcome measures were the association between gene expression and colorectal incidence in the different ethnic groups. RESULTS: Ashkenazi Jews have the highest rate of colorectal cancer, and are diagnosed at an early stage compared with Palestinians (72% and 33% of the cases are in Dukes' A and B, respectively), and, hence, this may explain the better 5-year survival rate among this group. Sephardic Jews are diagnosed at a more advanced stage, the tumors are poorly differentiated and they lack p27. Palestinians have significantly higher cyclin D1 levels. There was a statistically significant inverse correlation between the expression of beta-catenine and cyclin D1, as well as p53 and p27 (P <0.05). CONCLUSIONS: Increased expression of cyclin D1, p53, Ki-67, beta-catenine and Her-2/neu, and decreased expression of p27 may be important events in the three ethnic groups with colorectal cancer. The lower mortality rate among Ashkenazi Jews may be partially explained by their better molecular biology profile. (+info)
Postprandial hyperglycemia and insulin sensitivity differ among lean young adults of different ethnicities.
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Both postprandial hyperglycemia and insulin resistance (IR) have implications for the development of cardiovascular disease. The present study was designed to examine differences in postprandial glycemia and insulin sensitivity among young adults of different ethnic origins. Lean, healthy subjects (n = 60) from five ethnic groups [20 European Caucasians, 10 Chinese, 10 South East (SE) Asians, 10 Asian Indians and 10 Arabic Caucasians] were matched for age, body mass index, waist circumference, birth weight and current diet. A 75-g white bread carbohydrate challenge was fed to assess postprandial glycemia and insulinemia. Insulin sensitivity was assessed in three groups by the euglycemic-hyperinsulinemic clamp and in all subjects by homeostasis model assessment (HOMA) modeling. Postprandial hyperglycemia (incremental area under the curve) and insulin sensitivity (M-value) both showed a twofold variation among the groups (P < 0.001) and were significantly related to each other (R(2) = 56%, P < 0.001). Young SE Asians had the highest postprandial glycemia and lowest insulin sensitivity, whereas European and Arabic Caucasian subjects were the most insulin sensitive and carbohydrate tolerant. These findings suggest that IR is evident even in lean, young adults of some ethnic groups and is associated with significant increases in postprandial glycemia and insulinemia in response to a realistic carbohydrate load. (+info)
Outcomes of an intervention programme for treatment of asthma in a primary care clinic for Bedouins in southern Israel.
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BACKGROUND: Asthma is one of the most common disorders affecting children and adults. There is a large variation in the theoretical and practical knowledge and skills of physicians, and patients often do not receive optimal treatment. Thus, asthma represents a great challenge to the primary health care system. OBJECTIVE: Our aim was to evaluate an intervention programme for the optimization of treatment of asthma in a primary care clinic in the Muslim Bedouin sector in southern Israel. METHODS: Over a 3-month period, data were collected on the number of nebulizer treatments received by asthma patients in the clinic, referrals to the emergency room, hospitalizations and availability of electric nebulizer equipment or space chambers in the homes of children with asthma. Following this, an intervention programme was designed and implemented to improve treatment of asthma. At the end of the intervention 1 year later, the same data were again collected in the same season as the pre-intervention data. RESULTS: Of 3428 children registered in the clinic, 267 were diagnosed with asthma (7.8%). During the 3-month period before the intervention, 73 children had home inhalation equipment, 61 referrals to the emergency room were documented and six children were hospitalized for exacerbation or complications of the disease. Over this time period, 5.54 nebulizer treatments were conducted in the clinic per month per 100 children and adults. Following the intervention, the number of referrals to the emergency was reduced to six children, none of whom was hospitalized. The number of children with home nebulizers was doubled. The number of nebulizer treatments in the clinic dropped to 4.7 per month per 100, a reduction of 15%. CONCLUSIONS: An intervention including self-management of asthma with an emphasis on the proper use of inhalers and medications, together with improved disease management at the clinic itself, led to a reduction in the episodes of asthma and its complications. (+info)
Myopia in secondary school students in Mwanza City, Tanzania: the need for a national screening programme.
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BACKGROUND/AIMS: The prevalence of significant refractive errors and other eye diseases was measured in 2511 secondary school students aged 11-27 years in Mwanza City, Tanzania. Risk factors for myopia were explored. METHODS: A questionnaire assessed the students' socioeconomic background and exposure to near work followed by visual acuity assessment and a full eye examination. Non-cycloplegic objective and subjective refraction was done on all participants with visual acuity of worse than 6/12 in either eye without an obvious cause. RESULTS: 154 (6.1%) students had significant refractive errors. Myopia was the leading refractive error (5.6%). Amblyopia (0.4%), strabismus (0.2%), and other treatable eye disorders were uncommon. Only 30.3% of students with significant refractive errors wore spectacles before the survey. Age, sex, ethnicity, father's educational status, and a family history of siblings with spectacles were significant independent risk factors for myopia. CONCLUSION: The prevalence of uncorrected significant refractive errors is high enough to justify a regular school eye screening programme in secondary schools in Tanzania. Risk factors for myopia are similar to those reported in European, North-American, and Asian populations. (+info)
Diabetes among Bedouins in the Negev: the transition from a rare to a highly prevalent condition.
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BACKGROUND: Previous studies have shown a low prevalence of diabetes and other cardiovascular risk factors among Bedouins living in the Negev desert. New evidence suggests that diabetes is becoming highly prevalent. OBJECTIVES: To estimate the prevalence of diabetes in the town of Rahat, describe the cardiovascular risk factor profile and therapeutic modalities for diabetes and related conditions in this population, and compare these findings with those in the Jewish population. METHODS: A complete record review of all known diabetic individuals aged 35 and older registered at the Rahat Clinic (Clalit Health Services) was carried out by a trained nurse and a research assistant. Information on demographic, anthropometric and clinical characteristics was abstracted. Data on prescribed hypoglycemic agents and other medications were also obtained. RESULTS: Of the 316 known diabetic patients in the clinic, complete data were available for 271 (85.8%). The prevalence of known diabetes was 7.3% in males and 9.9% in females. Females had a significantly higher body mass index than males (30.9 vs. 29, P < 0.002), but lower levels of HBA1c and microalbuminuria. Oral hypoglycemic medications were taken by 69% of women and 76% of men, and insulin by 19% of women and 15% of men. CONCLUSIONS: Compared with data on Jewish diabetic patients in the Negev and Israel, the overall prevalence of diabetes in the population of Rahat is higher, but their cardiovascular risk profile is better, except for obesity. These findings support the hypothesis that diabetes and obesity have become major public health problems among Bedouins. (+info)