There are three known clinical syndromes of leishmaniasis: cutaneous (CL), mucocutaneous (MCL), and visceral disease (VL). In MCL and VL, treatment must be systemic (either oral or intravenous), while CL treatment options vary and include observation-only localized/topical treatment, oral medications, or parenteral drugs. Leishmaniasis treatment is difficult, with several factors to be considered. First, the efficacy of treatments varies among different species of parasites prevalent in different areas on the globe, with each species having a unique clinical presentation and resistance profile. Furthermore, leishmaniasis is a neglected tropical disease (NTD), resulting in a lack of evidence-based knowledge regarding treatment. Therefore, physicians often rely on case reports or case series studies, in the absence of randomized controlled trials (RCT), to assess treatment efficacy. Second, defining cure, especially in CL and MCL, may be difficult, as death of the parasite can be achieved in most cases, while the aesthetic result (e.g., scars) is hard to predict. This is a result of the biological nature of the disease, often diagnosed late in the course of disease (with possible keloid formation, etc.). Third, physicians must consider treatment ease of use and the safety profile of possible treatments. Thus, topical or oral treatments (for CL) are desirable and promote adherence. Fourth, the cost of the treatment is an important consideration. In this review, we aim to describe the diverse treatment options for different clinical manifestations of leishmaniasis. For each currently available treatment, we will discuss the various considerations mentioned above (efficacy, ease of use, safety, and cost).

Purpose: Robotic-assisted thoracic surgery (RATS) is increasingly used for thoracic procedures; however, there are various regional anesthesia techniques for optimal pain management. This study aimed to compare the analgesic effectiveness and perioperative outcomes of different regional anesthesia techniques with those of general anesthesia (GA) in patients undergoing RATS. Patients and Methods: We conducted a retrospective cohort study of adult patients undergoing elective RATS at Soroka University Medical Center from January 2018 to July 2024. Patients were grouped based on intraoperative pain management approach: thoracic epidural analgesia (TEA), thoracic paravertebral block (PVB), erector spinae plane (ESP) block, serratus anterior plane (SAP) block, or General anesthesia alone. Primary outcomes included postoperative pain (measured by Visual Analog Scale scores; VAS) and opioid consumption. Secondary outcomes included intraoperative hemodynamic stability, postoperative complications, and length of hospitalization. Results: A total of 158 patients were analyzed: TEA (n=5), PVB (n=65), ESP (n=40), SAP (n=14), and GA alone (n=34). Demographics and surgical characteristics were similar across groups. Significant differences were observed in Post-Anesthesia Care Unit (PACU) morphine use (p < 0.001), with the lowest consumption in the ESP (3.75 ± 5.51 mg) and SAP (3.92 ± 4.00 mg) groups and the highest in the GA group (12.42 ± 6.01 mg). PACU VAS scores at 30 minutes and 1 hour were significantly lower in the PVB, ESP, and SAP groups compared to GA (p < 0.01). Hypotension and vasopressor use were most frequent with TEA and PVB, while SAP and ESP were associated with better hemodynamic profiles. No significant differences were observed in postoperative infection rates or hospital stay duration. Conclusion: Regional pain management techniques, particularly ESP and SAP blocks, were associated with reduced pain and opioid use while maintaining hemodynamic stability compared to GA. Given the relatively small sample sizes in the TEA and SAP groups, these findings should be interpreted cautiously, and prospective studies are needed to confirm and refine these approaches.

Introduction: We assessed the efficacy of taurolidine lock (TL) in preventing catheter-related bloodstream infections (CRBSIs) and related hospitalizations in children with parenteral nutrition (PN) in the home setting. Methods: This study is a retrospective case series study. All children with intestinal failure in a single center in southern Israel who were administered PN and treated with TL between 2017 and 2024 were included. The rates of CRBSI episodes, related hospitalizations and pathogen distribution in the pre-TL and post-TL periods were compared. Results: Overall, 14 patients were included. The median pre-TL and post-TL periods were 990 and 1260 days, respectively. The rate of CRBSI episodes due to bacterial infection per 1000 days declined by 45%, from 6.2 to 3.7, with p = 0.0008, while fungal CRBSI rates were low (<10% of all positive cultures) and did not decline significantly. Similarly, the hospitalization episode rate per 1000 days declined by 41%, from 7.6 to 4.5, with p = 0.001. Conclusions: Taurolidine lock treatment for children with central-line PN resulted in a substantial decrease in CRBSI episodes and related hospitalizations.

Point-of-care ultrasound is rapidly gaining traction in clinical practice, including primary care. Yet, logistical challenges and geographical isolation hinder skill acquisition. Concurrently, an evidentiary gap exists concerning such guidance's effectiveness and optimal implementation in these settings. We developed a lung point-of-care ultrasound (POCUS) curriculum for primary care physicians in a rural, medically underserved region of the south of Israel. The course included recorded lectures, pre-course assessments, hands-on training, post-workshop lectures, and individual practice. To evaluate our course, we measured learning outcomes and physicians’ proficiency in different lung POCUS domains using hands-on technique assessment and gathered feedback on the course with a multi-modal perception approach: an original written pre- and post-perception and usage questionnaire. Fifty primary care physicians (PCPs) showed significant improvement in hands-on skills, increasing from 6 to 76% proficiency (p < 0.001), and in identifying normal versus abnormal views, improving from 54 to 74% accuracy (p < 0.001). Ten weeks after training, primary care physicians reported greater comfort using lung ultrasound, rising from 10 to 54% (p < 0.001), and improved grasp of its potential and limits, increasing from 27.5% to 84% (p < 0.001). Weekly usage increased from none to 50%, and the number of primary care physicians not using at all decreased from 72 to 26% (p < 0.001). A two-day focused in-person and remote self-learning lung-POCUS training significantly improved primary care physicians' lung ultrasound skills, comfort, and implementation.

Background: A growing volume of mental health research is conducted with participants recruited and responding online. However, to date, few psychometric scales have been specifically validated for online research. Objective: We aimed to devise a brief, 12-item version of the Center for Epidemiological Studies Depression Scale (CES-D) in which first order factors are sufficiently measured. Methods: We recruited 218 adults with depression and 226 comparison participants with no mental health history. Both groups completed the original 20-item CES-D and measures of social support, psychological distress, and sociodemographic information (eg, age, gender, and household income). Measurement of social support included online support, and psychological distress included symptoms of social media use disorder along with loneliness and life dissatisfaction. Results: This brief, 12-item version of the CES-D was devised with persons with depression and replicated with comparison participants. For both, core sadness, somatic symptoms, interpersonal detachment, and absence of well-being each significantly contributed to measurement of a higher-order depression latent construct (P<.01). Structural equation modeling was performed to establish the construct validity of this 4-factor model in which depression is predicted by socioeconomic factors and depression predicts lower social support as well as greater psychological distress. Conclusions: Responses to this 12-item, online version of the CES-D demonstrate factorial and construct validity. Clinical research is required in future to ascertain whether scores greater than 11 (of 36) are suggestive of elevated depressive symptomology.