[CORONA VIRUS, BREASTFEEDING AND GUIDELINES - A WORLDWIDE REVIEW].

INTRODUCTION: The COVID-19 pandemic has forced countries worldwide to face major issues and challenges. Among those challenges is breastfeeding from the first hours after birth until late infancy, in hospitals and communities. There is a consensus throughout the world and among leading international professional medical associations that breastfeeding is of significant importance for short- and long-term health outcomes in mothers and infants, as well as for its public health impact and reduction of national health expenditures. Moreover, breastfeeding or human milk feeding have been shown to reduce morbidity, specifically respiratory infections, among infants and children. This is not the first time health systems are dealing with coronavirus outbreaks, although currently, in the COVID-19 pandemic, there is still much that is unknown. Dealing with the unknown can lead to guidelines that may not fully take into consideration relevant risk benefit ratios for individuals and groups. In this review, we aim to summarize the guidelines of different leading professional groups around the world dealing with the COVID-19 pandemic. Evidence-based medicine rests on relevant scientific evidence, patients' values and preferences and clinical judgment. We wish to propose guidelines based on available evidence concerning breastfeeding, the current pandemic and weighing in potential risks and benefits while highlighting the need for ongoing breastfeeding research.

[CLINIC BLOOD PRESSURE MONITORING AS A PREDICTOR OF MASKED HYPERTENSION].

INTRODUCTION: Masked hypertension is strongly linked to morbidity and mortality. The phenomenon poses a challenge to physicians due to the difficult diagnosis. Recent studies have shown that the incidence may occur in 8.8% -16.6% of the population and up to 30.4% among people with borderline blood pressure. OBJECTIVES: To examine the prevalence of masked hypertension in the Israeli population and the clinic blood pressure status as a predictor of masked hypertension. METHODS: Interviewees were randomly recruited from among passers-by at Assuta Hospital in Ashdod. Those who were found to have normal and normal-high blood pressure ranges were included in the study. Ambulatory blood pressure monitoring was performed, and anthropometric measures were assessed. A statistical analysis compared groups according to their blood pressure clinical and ambulatory blood pressure categories. RESULTS: A total of 35 participants were included in this research. Masked hypertension was found among 35.3% of patients with normal range blood pressure and 27.7% of those in the borderline range. Significant differences were found between the normotensive group and the masked hypertension group in BMI, waist circumference, and clinical category of clinic diastolic blood pressure. CONCLUSIONS: A third of those with in-clinic normal blood pressure suffer from masked hypertension. Borderline in-clinic diastolic blood pressure is significantly associated with masked hypertension. DISCUSSION: This study presents higher masked hypertension rates than previously reported, the difference may be explained by differences in the nature and the lifestyle of the study population. The high incidence of the phenomenon indicates the need for further investigation of patients with in-clinic normal and borderline blood pressure.

[RESISTIVE INDEX - A POSSIBLE SUBTLE INDEX OF KIDNEY DYSFUNCTION IN PRE-HYPERTENSIVE PATIENTS].

INTRODUCTION: The phenomenon of "masked hypertension" is a diagnostic challenge for physicians. The renal resistance index is a radiological index that expresses damage to the renal blood vessels. The literature regarding the relationship between the renal resistance index and primary kidney disease (as a cause of hypertension) or kidney disease as a result of hypertension is low and limited. OBJECTIVES: The aim of this study is to examine the reliability of the renal resistive index as a means of detecting masked hypertension. METHODS: Respondents were recruited at random, those who were found within normal and normal-high blood pressure ranges were included in the study. A renal ultrasound and ambulatory blood pressure monitoring were performed, and anthropometric measures were assessed. A statistical analysis compared groups according to their blood pressure clinical category and the presence of masked hypertension versus normal. RESULTS: No significant difference was found between the study groups in the renal resistance indices. CONCLUSIONS: The renal resistive index is not an appropriate tool for assessing the presence of masked hypertension in patients with in-clinic pre-hypertension. DISCUSSION: The results of the study were consistent with previous studies that question the clinical use of the renal resistive index. There is no room for using the renal resistive index as a tool to assess the likelihood of masked hypertension in patients with in-clinic pre-hypertension.

Inexperienced but Confident: A Survey of Advanced Life Support Providers and Life-saving Interventions in the Israel Defense Forces.

OBJECTIVE: The objective of this study was to assess the current experience of Israel Defense Forces' (IDF) advanced life support (ALS) providers in performing life-saving interventions (LSIs), the rate of doctors and paramedics achieving the Trauma and Combat Medicine Branch benchmarks, and the rate of providers feeling confident in performing the interventions although not achieving the benchmarks. METHODS: This study was based on an online survey delivered to IDF ALS providers. The survey investigated demographics; experience in performing endotracheal intubation, cricothyroidotomy, tube thoracostomy, and intraosseous access on human patients; and confidence in performing these LSIs. All benchmarks chosen referred to the number of times performed in the previous year. The benchmarks were 20 for intubation, 3 for cricothyroidotomy, 4 for tube thoracostomy, and 3 for intraosseous access. RESULTS: During the survey period, 175 IDF ALS providers started the survey, but only 138 (79%) completed it, 93 (67%) of them were paramedics. Doctors had higher rates than paramedics of failing to achieve the benchmarks for intubation (96 vs. 57%, P < .001) and intraosseous access (100 vs. 66%, P < .001). All respondents failed to achieve the benchmark for cricothyroidotomy, and all but one paramedic failed to achieve the tube thoracostomy benchmark. Doctors had lower rates of high confidence when failing to achieve the benchmark for intubation (35 vs. 64%, P = .008) and intraosseous access (7 vs. 31%, P = .005) compared to paramedics. CONCLUSION: IDF ALS providers have alarmingly limited experience in performing LSIs. Many of them are confident in their ability despite not achieving evidence-based benchmarks. Additional training is required, maybe as a part of an annual medical fitness test.