A Rare Multi-vessel Spontaneous Coronary Artery Dissection Case Requiring Balloon Intervention.

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. This case involves a multivessel SCAD requiring intervention. The patient is a 39-year-old woman suffering from a non-ST elevation myocardial infarction caused by SCAD. The first coronary angiography revealed changes suggestive of acute distal left anterior descending (LAD) spontaneous dissection with partial occlusion and changes suggestive of old distal left anterior circumflex artery and obtuse marginal spontaneous dissections. A repeated angiogram revealed total occlusion of the distal LAD. Balloon angioplasty was done to the distal LAD, achieving a good flow. This case highlights the importance of diagnosis and treatment of SCAD. This case enhances our knowledge of atypical SCAD presentation (multi-vessel and required intervention) and emphasizes the need for individualized management strategies for optimal outcomes in each case.

Factors affecting survival of Shigatoxin-producing Escherichia coli on abiotic surfaces.

Shigatoxin-producing Escherichia coli (STEC) causes severe infections, and has been the cause of a number of foodborne outbreaks. Knowledge on the survival of STEC is crucial in order to limit the risk of cross contamination and transfer of STEC to food during processing. In this study survival of STEC and non-STEC on surfaces under various humidities, temperatures and in the presence of different types of soil was investigated. A model system with controlled relative humidity and temperature was established by using saturated salt solutions. All the 12 STEC strains had a reduction in viable count during incubation at 70% RH at 12 degrees C. The reduction was 2-3.5 log and 4.5-5.5 log after 1 and 7 days of incubation, respectively. Surviving cells were observed after 19 days of incubation. The STEC strains were more resistant to desiccation than non-STEC strains. STEC survived better at 12 degrees C, compared to 20 degrees C. The survival of STEC was much lower than the survival of a Staphylococcus simulans strain tested, which showed less than 1 log reduction until day 7 at 70% RH at 12 degrees C, while several STEC strains had comparable survival to a Salmonella Agona strain. The survival of two STEC strains tested was highest at 98% RH. The lowest survival was observed at 85% RH, with better survival at drier conditions. Presence of proteins and glucose protected the cells at dry conditions. Two commercial disinfectants tested at in-use concentration had limited effect (0.8-2.5 log reduction) against STEC on stainless steel, especially for cells incubated at high relative humidity (98% RH). STEC surviving on surfaces in the food industry may impose a risk for cross contamination. Cleaning and use of suitable disinfectants will reduce the survival of STEC, but surfaces should be allowed to dry completely since humid conditions will promote the survival and growth of STEC.

Value patterns and content among families of Soviet immigrants: SYMLOG analysis.

The purpose of this qualitative study is to understand and compare two immigrant families whose children perceived their families to be well-functioning, and two families whose children perceived them to be poor-functioning. The method of analysis used for studying the values of the families is based on SYMLOG. Four families, who immigrated to Israel during the early seventies from the former USSR, and whose adolescents were born in Israel, were interviewed. The results show that in the two "well-functioning" families, there is a high degree of consensus on their values-those that they accept, as well as, those that they reject. The two "poor-functioning" families did not exhibit identical value patterns--neither in the values that they favor, nor in those that they reject. In terms of content, in the well-functioning families, there was a strong expression of two values: friendliness and the desirability of self-sacrifice in order to reach family goals. In contrast, in the poor-functioning families, the value of conservatism was salient. Finally, all four families expressed strong opposition to the values of strong individualism and nonconformity. Suggestions for family intervention are offered.

Blood pressure among immigrants to Israel from areas affected by the Chernobyl disaster.

OBJECTIVES: To validate and analyze apparent association of hypertension with exposures to radiation at Chernobyl among immigrants to Israel from the contaminated areas. METHODS: Data were collected in 1991 and 1994 from two samples of persons who immigrated to Israel from the contaminated zone around the Chernobyl nuclear power plant. The first sample were self-referred for evaluation in a clinic by whole-body cesium measurement, physical examination, and questionnaire (N = 756, 328 from less exposed and 438 from more exposed areas). The second wave data were collected in 1994 during home interviews for evaluation of psychosocial factors associated with their experience (N = 708, 121 from more exposed and 253 from less exposed areas). In the second study a referent group was included (n = 334) who were matched by age, sex, and year of immigration who immigrated from other areas outside of the contaminated zone. Estimates of exposure were based on the IAEA map of ground-level cesium isotope (137Cs) contamination. RESULTS: In the 1991 sample, 21% from high exposure areas and 16% from less exposed areas had elevated systolic blood pressure (> 140 mmHg). Elevated diastolic blood pressure (> 90 mmHg) had a similar difference between more and less exposed groups (21% and 16%). Age- and sex-specific analyses showed that statistically different levels were found in the older age groups. In the 1994 sample, we confirmed a relationship between exposure and elevated blood pressure. 33% of those from the more exposed areas and 34% of those from less exposed areas had elevated systolic blood pressure, compared with 23% of the comparison group, with a similar trend found in diastolic blood pressure. The relationship between exposure and blood pressure was accentuated in the group of respondents who had high scores on PTSD symptoms. Of the psychological variables analyzed, systolic blood pressure was most strongly related to cancer-related anxiety and somatization. A discriminant function analysis showed that three variables: age, reporting a significant loss from the Chernobyl accident, and fear of cancer correctly differentiated 72% of those with normal and high blood pressure. CONCLUSIONS: There is a relationship between exposure to Chernobyl and high blood pressure, partly due to the psychological reactions to the accident.

Lessons learned from the study of immigrants to Israel from areas of Russia, Belarus, and Ukraine contaminated by the Chernobyl accident.

During the past 6 years, immigration to Israel of 700,000 persons from the former Soviet Union (FSU) included about 140,000 from radiocontaminated regions of Belarus, Ukraine, and Russia near Chernobyl. In Beer Sheva, a major center for immigrant absorption in Israel, a primary objective was to evaluate their health status and to refer them for care. 137Cs levels in 1228 men, women, and children were measured with a portable whole-body counter. Whole-body counts showed clear correlation with the degree of 137Cs ground contamination in previous regions of residence. The population could thus be sub-divided according to degree of exposure, based on previous regions of residence. The thyroid status of 300 local immigrant children was evaluated because of the increased risk of childhood thyroid cancer in the regions from which they came. This group was subdivided into comparative groups of children who came from less and more contaminated areas according to the International Atomic Energy Agency soil 137Cs contamination maps. Enlarged thyroids were found in about 40% of both groups. One 12-year-old girl from Gomel had a malignant papillary carcinoma. Thyroid-stimulating hormone levels, though within normal limits, were significantly greater (p < 0.02) for girls from high exposure regions. Liquidators showed significant increases in serum clastogenic factor and in the number of circulating glycophorin A-mutated red cells. In studies of over 700 people from both radiocontaminated and unaffected regions of the FSU, evidence for posttraumatic stress disorder was found more frequently in persons coming from the more contaminated areas.

Bridging the gap in mental health approaches between east and west: the psychosocial consequences of radiation exposure.

Mental health professionals in Western countries and the Confederation of Independent States ([CIS], the former Soviet Union) have been examining the social and psychological consequences of the 1986 Chernobyl nuclear accident on the people who lived or are living in the exposed areas. Based on reviews of the literature, papers from international conferences, and communication between researchers in various countries, different perspectives have emerged on classifying distress and disorders and designing treatment programs. The origins of these differences lie in philosophical, historical, and political developments in the West and the CIS. These different approaches often have made it difficult for mental health professionals from the CIS and the West to work together. The goal of this paper is 2-fold: to identify and recognize the main differences in these approaches and to propose specific solutions for bridging the gap. The basic approach of mental health professionals in the CIS is a physiological, nosological one--it focuses on the etiology of the illness. Although their main diagnostic tool is the International Classification of Diseases, 10th Revision, it has undergone adaptations that reflect the Soviet medical and physiological attitude toward psychiatry. These changes have resulted in the abrogation and addition of disorder categories. For example, in the CIS edition of the ICD-9, there is no mention of post traumatic stress disorder as a distinct disorder. In contrast, in the West, the dominant approach is a symptomatic, phenomenologic one. Emphasis is placed on a dynamic understanding of the disorder and treatment is conducted by mental health professional (psychologists, social workers, psychiatrists). This contrasts with the approach used in the CIS, where psychological distress often is somaticized and treatment undertaken by physicians rather than mental health professionals. The authors of this paper call on researchers to come together and work jointly on the recognition and resolution of these differences. Then both groups will be able to offer concrete solutions and build tools that can benefit both sides. It is hoped that these new approaches will receive worldwide recognition and prove useful for other mental health professionals working with persons affected by the accident at Chernobyl.

Two-year follow up study of stress-related disorders among immigrants to Israel from the Chernobyl area.

We report on findings from a 2-year follow-up study of immigrants originating from exposed areas around the site of the 1986 Chernobyl accident matched with comparison subjects emigrating from other republics in the Confederation of Independent States. In the initial study of 708 immigrants, the samples were matched by age, gender, and year of immigration. We assessed two exposure groups--high and low--by estimating levels of ground cesium contamination from the International Atomic Energy Agency maps. We reinterviewed 520 immigrants from the first wave of data collection (a reinterview rate of 73%), 87 from high-exposure areas, 217 from low-exposure areas, and 216 comparison subjects. This study examined the prevalence of symptoms of posttraumatic stress disorders (PTSD), depression, somatization, anxiety, and physical effects (high blood pressure, acute symptoms, and chronic illness). The results obtained in the first wave conducted 8 years after the accident showed that psychological symptoms were significantly higher in exposed respondents than in the comparison group. During the second wave (10 years after the accident) we observed a decline in the prevalence of PTSD and related distress except for somatization, which remained at the same level. An association between exposure and high blood pressure was observed in the first wave of data, but was not still significant in the second wave of data collection. The proportion of those who reported three or more chronic health problems was 48.3% among the high-exposure group, 49.3% in the low-exposure group, and 30.6% in the comparison group (p = 0.0003). The most commonly reported problems were heart disease. problems with vision or hearing, migraine headaches, problems with the lymphatic system, and arthritis. Based on the results, it was concluded that the Chernobyl accident was a powerful stressor, having a strong impact on both mental and physical health. Since all respondents were engaged in the process of acculturation and accommodation to a new country after emigration, it is encouraging that this study shows that levels of psychological distress are waning as the new immigrants are absorbed into Israeli society. However, there still remains some independent effect on health associated with the experience of the Chernobyl accident.