[HE GAVE EVERYTHING HE HAD: DR. SHLOMO GURFINKEL - A LAST DESCENDANT].

INTRODUCTION: Holocaust survivors gave a significant contribution to Israel's fighting forces and to the victory in the War of Independence. Many of them lost their lives in the battlefields. Many doctors who were survivors took an active part in the war, and afterwards in the building of the base of public medicine in the country. The "Last Descendants" were those Holocaust survivors who remained the last remnant of their nuclear family (parents, brothers, sisters, sons and daughters), who immigrated to Israel, joined the army and fell in battle, thus ending forever their family legacy. One of them was Dr. Shlomo Gurfinkel. During World War II he was a member of the Jewish underground and served as a doctor in Vilna's ghetto and in the ranks of the partisans. In the War of Independence, he was a doctor in a "Haganah" battalion and lost his life in the battles in Jerusalem. By telling his personal story, we intend to throw light on the heroic actions of those Holocaust survivors, amongst them medical personnel, who came to Israel and joined the fighting forces, including those who were "last descendants".

[MY GLORIOUS BROTHERS - JEWISH DOCTORS ON THE RESISTANCE FRONT AGAINST NAZIS AND THEIR COLLABORATORS].

INTRODUCTION: Many Jewish doctors in the Holocaust - in ghettos, concentration and extermination camps and in the forests - displayed courage, valor and sacrifice in the resistance front against the Nazis and their allies. The scope of their actions was broad: active resistance in the underground and rebellion movements or in the lines of partisans in the forests; hiding and saving Jews; smuggling medicines; preparing false medical records; secretly conducting surgery and other treatments; refusing the demands to submit lists of patients and workers, thus sentencing them to death; staying by the sick and the needy in the ghettos, even when they could escape, and many more. All this was done out of truth to their conscience, sometimes even beyond their commitment to the doctor's oath, placing themselves in uncertain situations, in distress, hunger, oppression and humiliation, risking their own lives and those of their families. It is admirable how those degrees of courage, bravery, willpower and sacrifice could develop out of such terrible physical and mental distress. The resistance was an extensive wide-ranging occurrence among the Jewish doctors and not one of just a few individuals. This article presents a number of examples of diverse forms of resistance, of individuals as well as of groups of physicians.

[PHYSICIANS RIGHTEOUS AMONG THE NATIONS AND OTHER HEROES].

INTRODUCTION: As of 1.1.2013, out of 24,811 persons awarded the status of Righteous Among the Nations, 245 (1%) were physicians and 31 were medical students. They were active in helping and saving Jews in various ways: surgery for hiding signs of Jewish identity, hospitalizations, smuggling medical supplies into the ghettos, providing false documents, hiding people and active fighting. We must remember them and pay them homage. We are equally obligated to the Jewish physicians, who saved the lives of other Jews during the Holocaust, at the risk of their own lives.

Reconsidering the Current Preterm Premature Rupture of Membranes Antibiotic Prophylactic Protocol.

OBJECTIVE: The purpose of our study was to determine whether the current antibiotic regimen for preterm premature rupture of membranes (PPROM) is adequate for covering the current causative agents and sensitivities of chorioamnionitis and early-onset neonatal sepsis. STUDY DESIGN: During a 3-year period, we retrieved the results from placental and amniotic membrane cultures obtained at delivery in cases of maternal fever, chorioamnionitis, and PPROM, and from blood cultures obtained from neonates with early-onset sepsis (EOS) in three participating hospitals. Sensitivity of pathogens to antimicrobial agents was performed using routine microbiologic techniques. RESULTS: There were 1,133 positive placental or amniotic cultures, 740 (65.3%) were from gram-negative Enterobacteriaceae. There were 27 neonates diagnosed with EOS with positive blood cultures. Aerobic Enterobacteriaceae accounted for 14 cases (52%) and group B streptococcus for 7 cases (26%). Of the Escherichia coli and Klebsiella sp., only 38% were sensitive to ampicillin. CONCLUSION: Local pathogens and their antibiotic sensitivity profiles should be explored every few years and an effective antibiotic protocol chosen to cover the main pathogens causing chorioamnionitis and EOS. Consideration should be made for changing ampicillin in women with PPROM to a regimen with better coverage of gram-negative Enterobacteriaceae.

[THE VALLEY IS A DREAM"--ON THE HISTORY OF THE NEONATAL INTENSIVE CARE UNIT IN THE HA'EMEK MEDICAL CENTER].

The establishment of the Cooperative Merhavia in 1910 marked the beginning of the settlement in the Jezreel Valley. The medical services started to develop almost simultaneously, with a small number of physicians and nurses who came in the wake of the first settlers and set up infirmaries in the region's communities mainly to treat malaria and other infectious diseases. The Ha'Emek Medical Center, which celebrates 90 years since its foundation, was the first hospital of Kupat Holim. It started out in a few temporary buildings in Kibbutz Ein Harod and was then transferred to its present location in Afula. Records of treatment of preterm babies go as far back as the 1950s. The Neonatal Intensive Care Unit in Afula was one of the first in Israel and, for many years, served as a referral center for hospitals in the North and Sharon regions, until similar departments were gradually founded. The history of the Neonatal Department of the Ha'Emek Medical Center is described, on the background of the development of the medical services, since the earliest settlement in the Jezreel Valley and the foundation of the hospital in Afula.

Mutated NDUFS6 is the cause of fatal neonatal lactic acidemia in Caucasus Jews.

NADH:ubiquinone oxidoreductase (complex I; EC 1.6.5.3), the largest respiratory chain complex is composed of 45 proteins and is located at the mitochondrial inner membrane. Defects in complex I are associated with energy generation disorders, of which the most severe is congenital lactic acidosis. We report on four infants from two unrelated families of Jewish Caucasus origin with fatal neonatal lactic acidemia due to isolated complex I deficiency. Whole genome homozygosity mapping, identified a 2.6 Mb region of identical haplotype in the affected babies. Sequence analysis of the nuclear gene encoding for the NDUFS6 mitochondrial complex I subunit located within this region identified the c.344G>A homozygous mutation resulting in substitution of a highly evolutionary conserved cysteine residue by tyrosine. This is the second report of NDUFS6 mutation in humans. Both reports describe three diverse homozygous mutations with variable consequential NDUFS6 protein defects that result in similar phenotype. Our study further emphasizes that NDUFS6 sequence should be analyzed in patients presenting with lethal neonatal lactic acidemia due to isolated complex I deficiency.

Parental and perinatal factors affecting childhood anthropometry of very-low-birth-weight premature infants: a population-based survey.

BACKGROUND: The perinatal-neonatal course of very-low-birth-weight (VLBW) infants might affect their childhood growth. We evaluated the effect of parental anthropometry and perinatal and neonatal morbidity of VLBW neonates on their childhood growth. METHODS: We obtained parental anthropometry, height and weight at age 6-10.5 years of 334 children born as VLBW infants. Parental, perinatal and neonatal data of these children were tested for association with childhood anthropometry. RESULTS: (1) Maternal and paternal weight standard deviation score (SDS) and discharge weight (DW) SDS were associated with childhood weight SDS (R(2)= 0.111, p < 0.00001); (2) Maternal and paternal height SDS, corrected gestational age (GA) at discharge, maternal assisted reproduction and SGA status were associated with childhood height SDS (R(2)= 0.208, p < 0.00001); (3) paternal weight SDS, DW SDS and surfactant therapy were associated with childhood body mass index (BMI) SDS (R(2)= 0.096, p < 0.00001). 31.1% of VLBW infants had DW SDS < -1.88, and are to be considered small for gestational age ('SGA'). One quarter of these infants did not catch up by age 6-10.5 years. CONCLUSION: Childhood anthropometry of VLBW infants depends on parental anthropometry, postnatal respiratory morbidity and growth parameters at birth and at discharge. Almost one-third of VLBW premature infants had growth restriction at discharge from neonatal intensive care unit (NICU), a quarter of whom did not catch up by age 6-10.5 years.

Lowest neonatal serum sodium predicts sodium intake in low birth weight children.

Forty-one children aged 10.5 +/- 0.2 years (range, 8.0-15.0 yr), born with low birth weight of 1,218.2 +/- 36.6 g (range, 765-1,580 g) were selected from hospital archives on the basis of whether they had received neonatal diuretic treatment or as healthy matched controls. The children were tested for salt appetite and sweet preference, including rating of preferred concentration of salt in tomato soup (and sugar in tea), ratings of oral spray (NaCl and sucrose solutions), intake of salt or sweet snack items, and a food-seasoning, liking, and dietary questionnaire. Results showed that sodium appetite was not related to neonatal diuretic treatment, birth weight, or gestational age. However, there was a robust inverse correlation (r = -0.445, P < 0.005) between reported dietary sodium intake and the neonatal lowest serum sodium level (NLS) recorded for each child as an index of sodium loss. The relationship of NLS and dietary sodium intake was found in both boys and girls and in both Arab and Jewish children, despite marked ethnic differences in dietary sources of sodium. Hence, low NLS predicts increased intake of dietary sodium in low birth weight children some 8-15 yr later. Taken together with other recent evidence, it is now clear that perinatal sodium loss, from a variety of causes, is a consistent and significant contributor to long-term sodium intake.

Congenital cytomegalovirus infection in Israel: screening in different subpopulations.

BACKGROUND: The incidence of congenital cytomegalovirus in Israel has never been determined, either in general or in relation to various population subgroups. We recently proved the utility of newborn urine polymerase chain reaction as a screening tool for congenital CMV. OBJECTIVES: To define the incidence of congenital CMV infection in two different subpopulations, as a model for the entire population of Israel. METHODS: Urine specimens were randomly collected from 2,000 newborns in Shaare Zedek Medical Center, Jerusalem, and HaEmek Medical Center, Afula (1,000 specimens each). These hospitals have many characteristic differences, presumably representing the diverse population of Israel. Urine specimens were subjected to a CMV PCR reaction and positive specimens were validated by urine viral culture. Maternal seroprevalence was determined in a representative sample of the mothers in each hospital. Epidemiologic characteristics of the mothers were extracted from hospital records and compared. RESULTS: The population in Shaare Zedek Medical Center was mostly Jewish (97.7%) and urban (87.0%), as compared to that of HaEmek Medical Center (49.2% and 61.0%, respectively, P < 0.01). Nevertheless, CMV seroprevalence was similar: 81.5% and 85%, respectively. Ten (1.0%) and 4 (0.4%) newborns, respectively, were found to have congenital CMV infection (not significant). CONCLUSIONS: The combined incidence of congenital CMV infection in the study population was 0.7% (95% confidence interval 0.3-1.0%). If this rate is extrapolated to the entire population of Israel, then a total of 945 cases of congenital CMV can be expected among the 135,000 annual deliveries. A nationwide screening program for congenital CMV should be considered.

Incidence and clinical manifestations of breast milk-acquired Cytomegalovirus infection in low birth weight infants.

OBJECTIVES: To determine the incidence and clinical manifestations of human breast milk (HMB)-associated acquired cytomegalovirus (CMV) infection in small premature infants. STUDY DESIGN: A prospective study of premature infants born at or prior to 32 weeks gestation, and or infants weighing 1500 g or less at birth. The babies were divided into two groups: Group 1 included babies of CMV seropositive mothers who received HBM throughout the study period. Group 2 included babies of seronegative mothers or babies that did not receive HBM at all. Urine sample were obtained once weekly from birth until the age of 8 weeks or until discharge and were tested for the presence of CMV-DNA by PCR. RESULTS: Four of 70 infants from group 1 (5.7%, 95% CI, 0 to 11%) acquired CMV infection between the ages of 3 and 7 weeks as compared to none of 26 babies in group 2. Only one infected baby had severe CMV disease with complete recovery. CONCLUSION: The relative incidence of HBM-associated CMV infection and the severity of HBM-associated CMV disease in premature infants are low.