Background: Patients with end-stage renal disease (ESRD) undergoing chronic hemodialysis are at high mortality and cardiovascular risk. This study was aimed to assess whether the CHA 2 DS 2-VASc score may be used for risk stratification of this population. Methods: Included were patients undergoing chronic hemodialysis at Meir Medical Center. The CHA 2 DS 2-VASc score was calculated for each patient at the initiation of hemodialysis. Patients were classified into 3 groups according to the CHA 2 DS 2-VASc score: 0-3 (low), 4-5 (intermediate), and ≥6 (high). The primary endpoint was the composite of all-cause mortality, myocardial infarction, and stroke during the first year of hemodialysis. Results: Of the 457 patients with ESRD, 181 (40%) had low, 193 (42%) intermediate, and 83 (18%) high CHA 2 DS 2-VASc scores. During the first year of hemodialysis, 109 (23.8%) patients died, 17 (3.7%) had a stroke, and 28 (6.1%) had a myocardial infarction. Compared to patients in the low CHA 2 DS 2-VASc score group, those in the intermediate and high score groups had higher risk for the composite endpoint (OR: 2.6, 95% CI: 1.6-4.2, p < 0.01 and OR: 4.2, 95% CI: 2.3-7.5, p < 0.01, respectively). Each 1-point increase in CHA 2 DS 2-VASc score was associated with a 38% increased risk for the composite endpoint, a 19% increased risk for 1-year myocardial infarction, and a 29% increased risk for 1-year stroke. Conclusions: Patients with ESRD are at an extremely high mortality and cardiovascular risk within the first year of hemodialysis. The CHA 2 DS 2-VASc score was strongly associated with adverse outcomes and may be used for risk stratification of these patients.

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Purpose Enterobacteriaceae producing extended-spectrum beta-lactamase (ESBL) are common pathogens of UTI in children and their prevalence is increasing worldwide. The aim of this study was to determine risk factors for ESBL-positive UTI and susceptibility to antibiotic treatments. Methods A retrospective cohort study conducted at Rambam Health Care Campus, a tertiary hospital in northern Israel. The study included patients younger than < 18 years old and ESBL positive UTI between January 2017 and December 2019. Patient demographics, previous antibiotic treatment, previous UTI episode, genitourinary tract abnormalities, identified organisms in urine cultures, and sensitivity to antibiotics were recorded. Results A total of 570 children who contributed 639 episodes of community-acquired ESBL UTI with 661 Enterobacteriaceae isolates. The median age was 1.3(IQR:0.69–5.9) years. Female comprised 87.9% of the patients. ESBL isolates were identified in 56 (9.8%) patients. Higher rates of resistance to oral antibiotic treatments were found in the ESBL-positive group compared to the ESBL-negative group; amoxicillin-clavulanic acid (65.2% vs 22.7%, p < 0.001, OR = 6.84), trimethoprim-sulfamethoxazole (59.4% vs 17.6%, p < 0.001, OR = 6.84), ciprofloxacin (34.8% vs 4.5%, p < 0.001, OR = 11.43), and to piperacillin-tazobactam (27.5% vs 6.4%, p < 0.001, OR = 5.54). Neither group was resistant to amikacin or carbapenem. Risk factors for ESBL-positive UTI were antibiotic treatment within the last three months (p = 0.002, OR = 3.68, CI:1.63–8.31) and known ESBL carriage (p < 0.001, OR = 13.18, CI:4.25–40.94). Conclusions Known ESBL carriage and recent antibiotic treatment were risk factors for ESBL UTI. High rate of resistance to oral empiric and prophylactic antibiotic treatments was detected. Amikacin as initial treatment in anticipation of culture susceptibility is reasonable.

It has been suggested that some of the adverse, long-term cardiovascular outcomes of smoking are mediated by impaired autonomic nervous system (ANS) activity. Yet, this association is currently inconclusive. Heart rate variability (HRV) and the deep breathing test (DBT) represent common quantitative markers of ANS activity due to their simplicity and reliability. This large cross-sectional study was designed to assess the effect of active smoking on ANS function as manifested by HRV or DBT abnormalities. Electrocardiograms were recorded at rest for 5 min and during forced metronomic breathing. HRV and DBT were calculated according to accepted standards. Participants were divided into two groups based on current smoking status. The study included 242 healthy volunteers (196 nonsmokers and 46 smokers). There were no significant differences in age, sex, and BMI between groups. Cumulative smoking exposure burden (CSEB) for the study group was 5.3 ± 1.3 pack-years. Comparative analysis of HRV and DBT parameters according to smoking status revealed no significant differences between groups. Significant (p < 0.05), yet weak or moderate correlations (r < 0.7) were found between CSEB and abnormal change in HRV parameters consistent with sympathetic overactivity and decreased parasympathetic tone. In conclusion, smoking for a relatively short period in healthy adults does not seem to lead to significant impairment in ANS function. Yet, the consequences of smoking seem to be amplified when cumulative exposure burden increases.