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Introduction: Survival rates of solid organ transplant recipients are steadily increasing. Chronic immunosuppression is a key to sustain the transplanted organ. Thus, these patients are at a higher risk for fulminant disease and severe complications of rhinosinusitis (RS). Surprisingly, this has been scarcely discussed in the literature., Objective: To analyze the characteristics and disease course of RS in solid organ transplant recipients., Materials and Methods: Retrospective study. Medical records of all solid organ transplant recipients with a diagnosis RS treated at a national transplant center between the years 2001 and 2016 were reviewed., Results: Of 4562 solid organ transplant recipients, a documented diagnosis of RS was identified only in 61 (1.3%) patients. Sixty-four patients presented with posttransplantation RS; of them, 54.5% had chronic RS (CRS) and the remaining 45.5% patients were diagnosed with acute RS. Microbial cultures grew almost exclusively bacterial pathogens. A documented invasive fungal infection was noted in only 2 patients. A total of 24 (40%) patients underwent endoscopic sinus surgery, the majority (22) for CRS. On subgroup analysis, surgical intervention was more frequent in lung transplant recipients ( P = .005). Neither specific disease nor surgical complications were found., Conclusions: Interestingly, acute fulminant infection or sinusitis complications in solid organ transplant patients were much lower than expected. CRS in this patient group was less frequent than expected as well. Whether chronic immunosuppression minimizes the likelihood for CRS deserves further investigation. A more surgically oriented approach in CRS patients may be favored early in the management course of medically refractory patients in light of patients excellent outcomes.

Obstructive sleep apnea (OSA) is a common disorder, characterized by cyclic cessation of airflow for 10 seconds or more. There is growing awareness that OSA is related to the development and progression of cardiovascular disease. However, only a few studies have associated OSA directly to major cardiovascular events. The aim of this study was to evaluate the relationship between OSA and cardiovascular morbidity in a well defined population of patients.The electronic database of the central district of a major health management organization was searched for all patients diagnosed with OSA in 2002-2010. For each patient identified, an age- and sex-matched patient was randomly selected from the members of the same health management organization who did not have OSA. Data on demographics, socioeconomic status, and relevant medical parameters were collected as well.The study population included 2797 patients, average age 58.1, in which 76.6% were males. There was a significant correlation between OSA and the presence of ischemic heart disease (P < 0.001), pulmonary hypertension (P < 0.001), congestive heart failure (P < 0.001), cardiomyopathy (P = 0.003), and arrhythmia (P < 0.001). OSA was also significantly correlated with low socioeconomic status (P < 0.001).OSA and cardiovascular disease were strongly correlated. As such, early diagnosis and treatment of OSA may change the course of both diseases. We suggest that sleep disordered breathing should be routinely assessed in patients with cardiovascular problems. An ear-nose-throat evaluation may also be important to rule out anatomic disorders that cause upper airway obstruction.

Objective: To evaluate the attitudes of Israeli intensive care physicians regarding intensive care unit (ICU) triage issues., Design: An opinion survey using questionnaires similar to those used in a previous study in the United States., Setting and Participants: Forty-three physicians, members of the Israel Society of Critical Care Medicine (45%)., Results: Important factors for admission to the last ICU bed were: small likelihood of surviving hospitalization, irreversibility of acute disorder, nature of chronic disorders and the physician's personal attitude. Most respondents would admit a patient with a predicted survival of a few weeks (70%) or a patient whose quality of life would be poor according to the physician's (98%) or patient's (77%) definition, to the last ICU bed. The personal attitude of the respondents and their own view of the patient's quality of life were considered as important as the quality of life as viewed by the patient. Israeli physicians tended to refuse patient admission into the ICU more than their US counterparts. Most Israeli physicians refused to discharge an ICU patient in order to admit another, despite bed shortage., Conclusions: The attitudes of Israeli intensive care physicians towards distribution of ICU resources differ from those of their United States counterparts; they are more paternalistic and comply less with requests for admission. Such attitudes are comparable to those expressed by some European intensive care physicians, highlighting the existence of diversity in the factors important to physicians' decision-making.

Background: Physicians' decisions regarding provision of life-sustaining treatment may be influenced considerably by non-medical variables., Objectives: To examine physicians' attitudes towards end-of-life decisions in Israel, comparing them to those found in the United States., Methods: A survey was conducted among members of the Israel Society of Critical Care Medicine using a questionnaire analogous to that used in a similar study in the USA., Results: Forty-three physicians (45%) responded, the majority of whom hold responsibility for withholding or withdrawing life-sustaining treatments. Preservation of life was considered the most important factor by 31 responders (72%). The quality of life as viewed by the patient was generally considered less important than the quality of life as viewed by the physician. Twenty-one responders (49%) considered withholding treatment more acceptable than withdrawing it. The main factors for decisions to withhold or withdraw therapy were a very low probability of survival of hospitalization, an irreversible acute disorder, and prior existence of chronic disorders. An almost similar percent of physicians (93% for Israel and 94% for the U.S.) apply Do Not Resuscitate orders in their intensive care units, but much less (28% vs. 95%) actually discuss these orders with the families of their patients., Conclusions: Critical care physicians in Israel place similar emphasis on the value of life as their U.S. counterparts and assign DNR orders with an incidence equaling that of the U.S. They differ from their U.S. counterparts in that they confer less significance to the will of the patient, and do not consult as much with families of patients regarding DNR orders.