Antoni Skripai

Aim: This study's aim is to evaluate temporal trends in antimicrobial resistance in Shigella sonnei , with a focus on the emergence of ceftriaxone‐resistant strains among paediatric patients. Methods: We conducted a 10‐year retrospective study of all paediatric patients diagnosed with Shigella sonnei via stool culture in our emergency department. Clinical features, laboratory results, and length of hospital stay were reviewed to assess trends in ceftriaxone resistance and compare between resistant and sensitive groups. Results: We analysed 180 paediatric Shigella sonnei cases. Of these, 177 (98.3%) were tested for ceftriaxone susceptibility: 156 (88.1%) were sensitive, and 21 (11.9%) resistant. Resistant strains emerged in 2022 (85.7%, 6/7), rising to 88.2% (15/17) in 2023, showing a strong correlation with calendar year ( p < 0.001). Resistant cases showed lower neutrophil ( p < 0.01) and sodium levels ( p < 0.006). Conclusion: Ceftriaxone‐resistant Shigella sonnei has risen sharply in Israel since 2022, mirroring global trends. This highlights the urgent need for strengthened antimicrobial resistance surveillance and to update current guidelines for the empiric treatment of childhood shigellosis.

Background/Objectives: Treatment planning for stage III non–small cell lung cancer (NSCLC) presents dosimetric challenges due to the proximity of critical structures. RapidPlan (RP), a knowledge-based planning (KBP) system, offers the potential for improved plan consistency and organ-at-risk (OAR) sparing. The objective of this study was to compare dosimetric and clinical outcomes of RP-generated plans versus manually optimized plans in patients with stage III NSCLC undergoing IMRT or VMAT. Methods: In this retrospective analysis, 50 patients treated with concurrent chemoradiation for stage III NSCLC at Hadassah Medical Center (2015–2021) were analyzed. RP plans were generated using a lung-specific model in the Eclipse treatment planning system and compared with the original clinical manual plans. Dosimetric parameters for target volumes and OARs were evaluated, and subgroup analyses were performed by technique (IMRT vs. VMAT). Toxicity and survival outcomes were analyzed, and Normal Tissue Complication Probability (NTCP) modeling was conducted. Results: RP significantly reduced mean heart dose (Δ = −2.54 Gy, p < 0.001), spinal cord maximum dose (Δ = −4.08 Gy, p < 0.001), and esophageal mean dose (Δ = −3.89 Gy, p < 0.001) compared with manual plans. Lung doses were slightly higher in RP plans (V20 Δ = +2.12%, p < 0.001). VMAT-RP plans demonstrated greater cardiac and esophageal sparing than VMAT-manual plans. RP yielded significant NTCP reductions for the heart (0.34% → 0.20%) and esophagus (16.6% → 11.5%), but no improvement for lung or spinal cord. Lung toxicity ≥ grade 2 was associated with reduced overall survival (16.2 vs. 51.8 months, p < 0.001). Conclusions: RapidPlan-based knowledge-based planning enhances OAR sparing while maintaining target coverage in locally advanced NSCLC. Slight increases in lung dose highlight the need for ongoing model refinement. An association between lung toxicity and reduced survival was observed, underscoring the impact of treatment-related morbidity on outcomes.

Background: Retrospective studies suggest that local radiotherapy on the prostate improves overall survival in the metastatic setting, but its benefit in patients with high-burden metastatic disease is still uncertain. Methods: We conducted a retrospective study of 100 high-metastatic-burden prostate cancer patients at Hadassah Ein Karem Medical Center from 2004 to 2021. Patients receiving local RT alongside standard treatment were compared to those receiving standard treatment alone. Prostate RT involved EBRT to the prostate/seminal vesicles with/without pelvic lymph nodes, delivering 54–60 Gy in up to 3 Gy fractions. The standard treatment used was ADT including or excluding chemotherapy. Subsequently, we performed 1:1 propensity score matching on 50 patients for further analysis. Results: The cohort had 100 patients split evenly between the RT and NRT groups. The RT group had higher Overall Survival than NRT (p < 0.046), remaining significant after Propensity Score Matching (PSM) (p < 0.034). Biochemical progression-free survival was also higher in RT vs. NRT (p < 0.033), maintaining significance after PSM (p < 0.042). RT patients reported longer symptom-free time vs. NRT (p < 0.017), though this difference did not persist post-PSM (p < 0.249). Post-PSM analysis showed higher loco-regional progression-free survival in the RT group vs. NRT (p < 0.049). Conclusions: Our study shows improved overall survival in the high-metastatic-burden group when adding RT to the standard treatment of choice, which persists after propensity score matching. The RT group in the entire cohort also demonstrated a reduction in progressing urinary symptoms and biochemical progression-free survival. These findings highlight radiotherapy’s potential as a viable treatment in these patients. However, prospective studies with comprehensive data collection are needed to fully address this topic.

Introduction: Radiation therapy plays an important role in the treatment of localized breast cancer. Hypofractionated (HF) radiation therapy has emerged as a promising alternative to conventional fractionation (CF) schedules, offering comparable efficacy with reduced treatment duration and costs. However, concerns remain regarding its safety and rate of toxicity, particularly in patients undergoing mastectomy with breast reconstruction. This study aimed to assess the implant-related complications in breast cancer patients receiving HF post-mastectomy radiation therapy (PMRT) and reconstruction compared to CF PMRT. Methods: A retrospective study was conducted on 59 breast cancer patients who underwent mastectomy and breast reconstruction between 2013 and 2021 and received adjuvant PMRT. Patient demographics, treatment characteristics, and implant-related complications were analyzed. Statistical tests including chi-square, Fischer’s exact test, and multivariable Cox regression were employed for analysis. Results: Of the 59 patients, 29 received HF PMRT and 30 received CF PMRT. At a median follow-up of 23.4 months, there was no significant difference in major implant-related complications between the two groups (24.1% in HF vs. 33.3% in CF, p = 0.436). Most complications in the HF group occurred within the first two years post-radiation. Age over 40 was identified as a significant predictor for higher implant-related complications (p = 0.029). Conclusions: Our findings indicate that HF PMRT and reconstruction does not increase the risk of major implant-related complications compared to CF PMRT. These results align with the existing literature, supporting the safety of HF radiation in breast cancer patients who underwent mastectomy with reconstruction.