Artemisinin-based combination therapies (ACTs) are recommended as first-line treatment against uncomplicated P. falciparum infection. Emergence of mutations in the PfKelch13 propeller domain has resulted in resistance to artemisinin in Southeast Asia. Mutations in Pfcoronin propeller domain confer reduced artemisinin susceptibility in vitro to an African Plasmodium strain, but their role in clinical resistance has not been established. We conducted a retrospective observational study of Israeli travellers returning from Sub-Saharan Africa with P. falciparum malaria, including patients with artemether-lumefantrine failure. Blood samples from all malaria-positive returning travellers are delivered to the national Parasitology Reference Laboratory along with personal information. Confirmation of malaria, species identification and comparative parasite-load analysis were performed using real-time PCR. DNA extractions from stored leftover samples were analysed for the presence of mutations in the Pfkelch13 (PF3D7_1343700) and Pfcoronin (PF3D7_1251200) genes. Age, weight, initial parasitemia level and Pfcoronin status were compared in patients who failed treatment versus responders. During 2009–2020, 338 patients had P. falciparum malaria acquired in Africa. Of those, 15 (24–69 years old, 14 males) failed treatment with artemether-lumefantrine. Four were still parasitemic at the end of treatment and 11 had malaria recrudescence. Treatment failure rates were 0% during 2009–2012, 9.1% during 2013–2016 and 17.4% during 2017–2020. In all patients the Pfkelch13 propeller domain had wild-type sequence. We did find the P76S mutation in the propeller domain of Pfcoronin in 4/15 (28.6%) of the treatment-failure cases compared to only 3/56 (5.5%) in the successfully treated patients (p = 0.027). The emergence of artemether-lumefantrine treatment failure was not associated with mutations in Pfkelch13. However, P76S mutation in the Pfcoronin gene was more frequently present in the treatment-failure group and merits further investigation. The increase of malaria incidence in Sub-Saharan-Africa partly attributed to the COVID-19 pandemic might also reflect a wider spread of ACT resistance.

Capillaria hepatica (syn. Calodium hepaticum) is a parasitic nematode of rodents, rarely infecting humans. An asymptomatic Israeli adult male with extensive travel history was diagnosed with a liver mass on routine post-thymectomy follow-up. Imaging and computer tomography (CT) guided biopsy were inconclusive. Surgical excision revealed an eosinophilic granuloma with fragments of a nematode suspected to be C. hepatica. Molecular methods verified the diagnosis, and the patient was treated empirically. This is the first case of hepatic capillariasis described in Israel, and the first to be diagnosed using molecular methods.

Civilians constitute a significant wartime target, and trauma accounts for most of their injuries. Air raid sirens have long been used to alert civilians of incoming attacks and have since expanded to warn from natural disasters. Sirens are known to cause significant emotional distress and physiological changes. Injuries inflicted from trauma while moving for shelter have yet to be described in the medical literature. During the recent Israel–Gaza conflict of May 2021, most of Israel’s population experienced rocket warning sirens. We collected all adult (18<) patients arriving at a major tertiary medical center emergency department (ED), attesting to having suffered their injury while rushing for shelter. Clinical and demographic data were retrieved and analyzed. A total of 48 patients were identified, with a mean age of 59.6 ± 20.0. Ten (21%) patients were admitted, and their mean length of stay was 4.4 ± 3.7 days. Women had a higher probability of being hospitalized (42.9% vs. 5.9%, P = .04), and those hospitalized tended to be older (68.8 ± 16.4 vs. 54.8 ± 20.8, P = .06). Elderly patients (65<) had a higher risk of injury. Extremity injuries were most common (50%), before head trauma (29%) and torso injuries (25%). Most patients (38/48, 79.2%) were discharged from the ED, and the rest were hospitalized for observation or surgery. One patient died from a head injury. This study implies that injuries while moving for shelter were a prevalent cause of physical injury to Israeli civilians during the Israel–Gaza 2021 conflict. Warning sirens injuries should be given appropriate attention—from prevention by directed media campaigns to post-conflict reimbursement.

Background: Plasmodium ovale is a rather neglected plasmodium. Rarity, a milder disease, and diagnostic difficulties compared to P. falciparum and P. vivax have led to this situation. This study’s objective is to present the epidemiological and diagnostical characteristics of imported P. ovale malaria in Israel. Methods: Malaria is a reportable disease in Israel. All highly-suspected cases are sent to the Ministry of Health central parasitology laboratory for molecular verification. We retrieved epidemiological and diagnostic data on all polymerase chain reaction (PCR)-proven P. ovale infections imported to between 2008 and 2020. Results: In total, 508 malaria cases were identified, 489 monoinfections and 19 (3.7%) mixed. 51 (10%) were due to P. ovale, among them 13 (25%) were mixed, comprising 68% of all mixed infections. 48/51 (94%) underwent blood microscopy, with a sensitivity of 94% (45/48) for genus identification and 15% (7/48) for P. ovale identification. Only 8% (1/12) of mixed infections were identified as such by microscopy. 42 (82%) patients underwent RDTs, with a sensitivity of 69% (29/42) for genus identification, and 62% (26/42) for identifying non-falciparum infections. Cycle threshold (Ct) values of P. ovale were significantly higher compared to P. falciparum and P. vivax in both mono and mixed infections (p < 0.05, p < 0.005). Ct levels in RDT positive vs. negative infections differed significantly (p < 0.05). Conclusion: P. ovale is commonly imported to Israel from Africa, with a high rate of mixed infections. The use of RDTs and microscopy is insufficient for the species-specific diagnosis of P. ovale, and must be complemented by PCR.

: Toxocariasis is a rare and underdiagnosed disease, and data concerning epidemiological aspects of toxocariasis in Israel are lacking. We describe the epidemiology of toxocariasis in Israel. Epidemiological data of all serology tests between 2005 and 2019 were retrieved and compared with detailed demographics. Overall, 464 positive cases from a total of 10,896 tests conducted were identified, reflecting a mean positivity rate of 4.4% (yearly range, 2–22%). Over the years, a significant increase in yearly tests was noted, without a parallel change in the positivity rate. The greatest positivity was noted among males and children (< 18 years). No differences were noted when comparing urban/rural and Jewish/non-Jewish sub-groups. A significant correlation between toxocariasis incidence and dog ownership rate was observed in major cities (r[8] = 0.82, P < 0.005). Our study shows that, in Israel, toxocariasis is not restricted to specific populations or locations. The risk factor of dog contacts was reiterated by nationwide dog registration data. There is need for a seroprevalence survey to understand the disease situation more fully.

The shortage in medical workforce is a global health problem, and a focus of health system policy makers and organizations. Worldwide, one of the solutions for providing adequate healthcare services has been the establishment of advanced practice provider (APP) roles. Israel was a late adopter of these professions. Contrarily, a unique profession arose locally in the early 2000's, the medical student resident assistant (MSRA). Defined as a post for Israeli medical students during their clinical years, who assist physicians with their medical work during evening shifts, and under their supervision. Since, working as an MSRA has become commonplace among Israeli medical students. In an attempt to estimate MSRA workforce trends since their emergence, we screened the Sheba Medical Center's employee data from 2003 to 2023. A total of 1,423 separate employee contracts were identified, with an average employment length of 2.0 years. The majority of MSRAs worked in the adult medicine departments (849, 60%), followed by surgery (220, 15%), pediatrics (208, 15%), obstetrics and gynecology (126, 9%), and psychiatry (11, 1%). Overall, 46% of MSRAs became interns and 25% became residents at the SMC. From a total of 595 current residents in the SMC, 118 (20%) had previously worked as MSRAs. Between 2022 and 2023, 29% of students from affiliated universities who conducted clerkships in the SMC were recruited as MSRAs. MSRAs, de-facto another readily available APP role, have been an integral part of the Israeli health system workforce in the last 20 years. Paid medical student assistantship programs like MSRAs could be a true "win-win-win" situation, combining experience-based medical education (ExBL) and paid work while supporting the overstretched health workforce. The effect of this role on the patient, on the system, and on the MSRAs themselves has not been described or researched. We call for extensive research on the clinical, academic, educational, occupational, financial and workforce aspects of the MSRA entity in Israel and suggest implementation of similar roles worldwide.