Eyal Meltzer

This study evaluated how informing clinicians about Clostridioides difficile (CD) carriage affected antibiotic stewardship. A quasi-experimental pre/post design assessed antibiotic use in carriers versus non-carriers. Clinician awareness was associated with reduced antibiotic use, particularly quinolones, among carriers. Findings suggest screening and targeted education enhance stewardship and reduce high-risk antibiotic use.

Introduction: Coronavirus disease 2019 (COVID-19) disease is associated with coagulopathy and an increased risk of thrombosis. An association between thrombin generation (TG) capacity, disease severity, and outcomes has not been well described. Methods: We assessed the correlation of TG with sequential organ failure assessment (SOFA) and sepsis-induced coagulopathy (SIC) scores and clinical outcomes by analysis of plasma samples obtained from hospitalized COVID-19 patients. Results: 32 patients (68.8% male), whose median age was 69 years, were assessed, of whom only 3 patients did not receive anticoagulant therapy. D-dimers were uniformly increased. During hospitalization, 2 patients suffered thrombosis, 3 experienced bleeding, and 12 died. TG parameters from anticoagulated COVID-19 patients did not significantly differ from the values obtained from non-anticoagulated healthy controls. Patients who received higher than prophylactic doses of anticoagulant therapy had increased lag time (p = 0.003), lower endogenous thrombin potential (ETP) (p = 0.037), and a reduced peak height (p = 0.006). ETP correlated with the SIC score (p = 0.038). None of the TG parameters correlated with the SOFA score or were associated with mortality. Conclusion: TG was not associated with disease severity among patients hospitalized with COVID-19. However, a correlation between ETP and the SIC score was noted and deserves attention.

Schistosomiasis remains an infrequent travel-related disease, mostly affecting returnees from Sub-Saharan Africa. The neglect of schistosomiasis research and development has consequences not only for endemic populations but also for travellers. Recent studies highlight deficits in clinical recognition, diagnostics and therapy of travel-related schistosomiasis, with significant morbidity, both acute and chronic.

To review the current status of 8-aminoquinolines in the prophylaxis of malaria among travelers, in light of the recent approval of tafenoquine.

Background: Travelers' diarrhea (TD) is frequently encountered in people traveling from high-income to low-income countries; however, its epidemiology in those traveling between high income countries is not known. Objectives: To evaluate the incidence of diarrhea in North American students relocating to Israel. Methods: A retrospective cohort study involving medical students from the United States and Canada relocating to Israel was conducted. Students who relocated to Israel during 2010-2016 were contacted by email to participate in an anonymous survey. Data included demographic information as well as occurrence, timing, duration, and outcome of diarrhea after relocation. Results: Ninety-seven students participated in the survey. Most (93.7%) students relocated from the United States or Canada. The period-prevalence of diarrhea was 69.1%. The incidence of diarrhea declined from 34.8 cases per 100 student-months during the first month after relocation to 1.3 cases per 100 student-months after 1 year. The duration of diarrhea was up to 1 week in 72.7%. Students who reported diarrhea were younger than students who did not (mean age 24.0 +/- 2.2 and 28.4 +/- 1.8 years, respectively, P < 0.001). No other demographic parameter was significantly associated with a higher likelihood of diarrhea. Conclusions: A high proportion of North American medical students relocating to Israel reported diarrhea with clinical and epidemiological features similar to classic TD. Further studies are needed to elucidate the causative agents of TD in Israel.