Itamar Feldman

Background: Hyperuricemia is associated with several risk factors for mortality and severe coronavirus disease 2019 (COVID-19) manifestations.

Thrombotic microangiopathy (TMA) is a syndrome characterized by thrombosis in capillaries and arterioles, resulting in microangiopathic hemolytic anemia, thrombocytopenia and target organ injury. In TMA presenting with severe hypertension, it is difficult to determine whether the TMA is primary and due to thrombotic thrombocytopenic purpura (TTP) or secondary to severe hypertension. The response to antihypertensive medication favors the diagnosis of severe hypertension as the cause of TMA. Comorbid inflammatory disease supports the diagnosis of TTP-induced TMA. This case describes a 75-year-old woman with Castleman disease who presented with severe hypertension and TMA. She improved with hypertension therapy. However, ADAMST13 showed zero activity, and the diagnosis was TTP. In cases of TMA accompanied by severe hypertension, it is challenging to diagnose the cause of TMA. Even when there is a pronounced clinical response to lowering blood pressure, the diagnosis of TTP should be considered, particularly when an inflammatory disease is present.

Background: Social distancing was the predominant strategy used to mitigate the spread of Coronavirus disease 2019 (COVID‐19) at the start of the COVID‐19 pandemic.Aims: To study the impact of social distancing on the incidence of bacteraemia. The number of admitted patients with positive blood cultures in April–May 2020 in one tertiary medical centre was compared with the number during the same period in the previous 3 years (April–May 2017–2019).Methods: Retrospective review of all positive blood cultures from January to July in the years 2017–2020.Results: There were fewer cases of Streptococcus bacteraemia as well as coagulase‐negative Staphylococcus bacteraemia and other possible contaminated blood cultures in April–May 2020. Compared with the previous 3 years, the incidence of Streptococcus pneumoniae bacteraemia among all bacteraemias was lower in April–May 2020 (5%) than in 2017–2019 (12.0%; 95% confidence interval 10.3–14.1%). In general, fewer cases of bacteraemia caused by oropharynx organisms were observed in April–May 2020; only 6 cases versus 31 (95% confidence interval 10–53) during the same period in 2017–2019. Only one case of S. pneumoniae bacteraemia was observed in April–May 2020 and its percentage among all bacteraemias was lower in April–May 2020 (0.4%) than during the same period in 2017–2019 (3.3%).Conclusion: The incidences of streptococcal bacteraemia and bacteraemia of organisms transmitted through respiratory secretions were lower when there were social distancing restrictions. Adopting measures of social distancing may decrease the morbidity from bacteraemia caused by oropharynx and respiratory bacteria.

Establishing smoke-free environments is a major component of tobacco control policy. The introduction of a smoke-free policy in medical campuses may serve as a role model for other educational and health institutions but little has been published about their prevalence or impact. In 2012, the Faculty of Medicine at Hebrew University–Hadassah in Jerusalem, Israel launched a smoke-free Medical Campus initiative. This study examined smoking behaviours, cigarette smoke exposure and attitudes towards the smoke-free campus policy among students and employees. Using a self-administered questionnaire, data was collected from medical, dental and pharmacy students, as well as employees of the school of pharmacy. We approached the entire target population in 2013 (N = 449), with a response rate of 72.5 % (N = 313). The rate of smoking was 8.3 % (95 % CI 5.5–11.9 %). Most participants reported daily exposure or exposure several times a week to cigarette smoke (65.8 %). Overall, 98.0 % had reported seeing people smoke in open campus areas and 27.2 % indoors. Most participants supported the smoking ban inside buildings (94.2 %) but fewer supported (40.8 %) a complete ban of smoking throughout the campus, including outside areas. Only 18.4 % agreed that a policy prohibiting smoking was unfair to smokers. A multivariable analysis showed that support for a complete ban on smoking on campus was higher among non-smokers than for smokers (OR = 9.5, 95 % CI 2.2–31.5, p = 0.02). The smoke-free policy does not have total compliance, despite the strong support among both students and employees for a smoke-free medical campus. The data collected will assist policy makers move towards a total smoke-free medical campus and will aid tobacco control efforts in Israel and other countries.