BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) strains are prevalent in healthcare and the community. Few studies have examined MRSA carriage among medical students.The aim of this study is to examine Staphylococcus aureus (SA) carriage, and particular MRSA, over time in cohort medical studentsMethodsProspective collection of nasal swabs from medical students in Israel and assessment of SA carriage. Three samples were taken per student in preclinical and clinical parts of studies. Antibiotic susceptibilities were recorded and MRSA typing was performed by staphylococcal cassette chromosome mec (SCCmec) types, Panton Valentine Leukocidin (PVL) encoding genes, and spa types. Clonality was assessed by pulsed-field gel electrophoresis.ResultsAmong 58 students, SA carriage rates increased from 33% to 38% to 41% at baseline (preclinical studies), 13 and 19 months (clinical studies), respectively (p = 0.07). Methicillin-susceptible SA (MSSA) carriage increased in the clinical studies period (22 to 41%, p = 0.01). Overall, seven students (12%) carried 13 MRSA isolates. MRSA isolates were PVL negative and were characterized as SCCmecII-t002, SCCmecIV-t032, or t12435 with untypable SCCmec. MRSA carriage during the pre-clinical studies was evident in 4/7 students. Two students carried different MRSA clones at various times and persistent MRSA carriage was noted in one student. Simultaneous carriage of MRSA and MSSA was not detected.ConclusionsMSSA carriage increased during the clinical part of studies in Israeli medical students. Compared with previous reports, higher rates of MRSA carriage were evident. MRSA strains were genotypically similar to Israeli healthcare-associated clones; however, carriage occurred largely before healthcare exposure, implying community-acquisition of hospital strains.

We show that LPN is technically feasible for T2 tumors, with acceptable intra- and perioperative outcomes. Furthermore, our results show a significant advantage in preservation of renal function for LPN without compromising oncologic results. Taken together, we believe that LPN should be considered for larger tumors based on technical feasibility rather than only tumor size.

Background There is significant evidence in the literature showing medical clowns reduce stress and anxiety in children during hospitalization, yet their effect on children's sleep remains unclear. The importance of sleep for recovery and overall health has been established, and sleep disturbances are common among hospitalized children. Methods This observational case-control study took place in the pediatric department of Carmel Medical Center and compared 42 hospitalized children divided into two groups of 21 participants. In the intervention group, the participants had an encounter with a medical clown before bedtime, and in the control group, there was no medical clown intervention. Participants were recruited based on matching the chief complaint or medical diagnosis and age in a 1:1 matching. Sleep parameters were objectively measured using an Actigraph device and subjectively evaluated through a parent questionnaire. We also collected data regarding demographics, vital signs, and length of stay. Results Children in the intervention group had significantly delayed wake-up time, longer total sleep time, reduced nocturnal wake time, and improved sleep efficiency compared to the control group. They also had a shorter hospital stay. Conclusion An encounter with a medical clown before bedtime positively impacts sleep parameters and shortens hospital stay in hospitalized children, thus may play a role in promoting better sleep in hospitalized children. Further research is needed to confirm these results.

En-bloc TUR specimen can lead to diagnose the horizontal and vertical margin. Horizontal margin positive is not associated with recurrence and we should perform 2 nd TUR in patients with vertical margin positive pT1 bladder cancer.

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