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The relationship between Q fever, caused by Coxiella burnetii, and obstetrical complications is debatable. Since Q fever is endemic in Israel, we aimed to assess its seroprevalence and clinical characteristics in pre-term deliveries. Between 1 August 2017 and 31 December 2019, we conducted serological screening for C. burnetii in pregnant women who presented to Rambam Health Care Campus with pre-term delivery (before 37 weeks of gestation). Anti-C. burnetii antibodies were tested first by enzyme-linked immunosorbent assay for the detection of phase I-IgG, phase II-IgG and phase II-IgM. Positive results were confirmed by indirect immunofluorescence with titre determination. Seropositivity was classified into past, acute and chronic infection. Demographic and clinical data of mothers and neonates were collected and compared between seropositive and seronegative women. Out of 386 pregnant women screened for anti-C. burnetii antibodies, 16 (4.1%) were seropositive, of whom three were diagnosed with past, 12 with acute and one with chronic infection. A higher percentage of seropositive women were immunosuppressed, 2/16 (12.5%) compared with 7/370 (1.9%) in seronegative women, (p = .05). Neonates with small for gestational age were born to 2/16 (12.5%) seropositive women compared with 29/370 (7.8%) to seronegative women, (p = .35). The seroprevalence of Q fever among pregnant women with pre-term birth reached 4% in northern Israel. This high rate in an endemic setting encourages investigating the role of routine screening for Q fever during pregnancy. Special attention should be given to pregnant immunosuppressed women at risk for exposure to Q fever., (© 2022 Wiley-VCH GmbH.)

Background: The World Health Organization classified coronavirus disease-19 (COVID-19) as a pandemic and recommends strict restrictions regarding most aspects of daily activities., Objectives: To evaluate whether the pandemic has changed the prenatal care and pregnancy outcome in pregnant women without COVID-19., Methods: The authors conducted a cross-sectional study to describe changes in outpatient clinic visits and to compare the rates of cesarean and instrumental deliveries between two periods of time: March-April 2020 (during the COVID-19 outbreak) with March-April of the preceding year, 2019., Results: During the COVID-19 outbreak, visits to obstetric triage, gynecologic triage, high-risk clinic, and ultrasound units decreased by 36.4%, 34.7%, 32.8%, and 18.1%, respectively. The medical center experienced a 17.8% drop in the total number of births (610 births) compared with March and April 2019 (742 births). During the outbreak women were more likely to be nulliparous (33.3% vs. 27.6%, P = 0.02) and present with hypertensive disorders during pregnancy (7.5% vs. 4%, P = 0.005) or gestational diabetes (13% vs. 10%, P = 0.03). More epidural analgesia was used (83.1% vs. 77.1%, P = 0.006). There were more operative vaginal deliveries during the outbreak (16.7% vs. 6.8%, P = 0.01). All other maternal and neonatal outcomes were comparable between the two periods., Conclusions: The medical facility experienced a major decline in all aspects of the routine obstetrics activities during the time of the pandemic. The higher rate of operative vaginal deliveries among nulliparous may be associated with the pandemic effect on the rate of high-risk patients.

Background: The use of ultrasound endovaginal probes is common practice in the fields of gynecology and obstetrics. The vagina serves as a host environment for many microorganisms, contributing greatly to its defensive mechanisms. It is not known whether the introduction of other microorganisms into the vaginal region are detrimental or require intensive preventative measures. Several national ultrasonography societies, as well as the Israel Ministry of Health, have addressed the proper and adequate handling of sonographic endovaginal probes, including the use of high-level disinfecting agents following cleansing and prior to using probe covers between patients. However, many obstetrics and gynecology ultrasound units in Israel find it difficult to adhere to these strict disinfecting requirements. While most of the guidelines are based on the theoretical risk of contaminations when ultrasound endovaginal probes are used, the rate of nosocomial infections linked to the use of these probes has yet to be verified. Based on the information available, there is an urgent need to find a solution that enables gynecological ultrasound users to properly disinfect endovaginal probes between patients. Currently, it is almost impossible to pragmatically adhere to the Israel Ministry of Health guidelines.

Prenatal diagnosis of Down syndrome is possible by using the technology of amniocentesis and chorionic villus sampling [CVS]. Since these invasive procedures carry the risk of fetal loss they are used only for patients at risk for Down syndrome. The development of screening programs based on biochemical and ultrasound markers allows us to choose only the high risk patients. Screening programs for Down syndrome have been developed very quickly during the last three decades, allowing us to detect 95% of pregnancies with Down's syndrome with a false positive rate of 5%. In addition, in the near future, we hope to have non-invasive methods to diagnose Down's syndrome based on fetal DNA detected in maternal blood. The new developments in Down's syndrome screening have been established in Israel according to guidelines published by the Ministry of Health. However, it is still necessary to clarify some confusion associated with this fast-growing technology.

Background: Early diagnosis and treatment of depression are of vital importance in dermatological patients., Objective: Our purpose was to evaluate the prevalence of depression among patients visiting a dermatology clinic in southern Israel., Methods: Patients who visited the dermatology clinic were interviewed using the Mini International Neuropsychiatric Interview screening tool., Results: The study included 384 patients. The screening questionnaire identified 37 patients (9.6%) with major depression, 3 patients (0.8%) with minor depression, and 74 patients (19.3%) with depressive symptoms. Higher prevalence of depression was found among widowers, among divorced or separated patients, and in unemployed patients. Depression was significantly associated with the perception of severity and suffering induced by the skin diseases., Limitations: The study was conducted in a cross-sectional design. To confirm causality, a longitudinal study should be conducted., Conclusion: Depression should be a consideration by dermatologists in the effective management of skin diseases.

Objective: To define the association between thrombophilia and unexplained stillbirth., Design: A case-control study., Setting: Obstetric department in a university affiliated hospital (Ha'Emek Medical Center, Afula)., Population: A total of 53 women who delivered stillborns between March 1998 and June 2002 and 59 women with unremarkable obstetric history who delivered at the same period., Methods: Presence of genetic and acquired markers of thrombophilia was investigated., Main Outcome Measure: Presence or absence of thrombophilia., Results: Thrombophilia was found in 34% of the women who delivered stillborns and in 20% of the 59 women with normal pregnancies (non-significant). However, significantly higher prevalence of thrombophilia (73%) was found in women who delivered small for gestational age stillborns compared with women who delivered normal birthweight stillborns (73%vs 18.4%, P < 0.0001)., Conclusions: There is no association between thrombophilia and stillbirth, overall. However, there is a clear association between thrombophilia and stillbirth of extremely growth restricted infants.

Trihexyphenidyl (THP) and other anticholinergics are liable to abuse by schizophrenic patients. Data concerning the incidence and characteristics of the abusers are scarce. In the present study an evaluation of 214 consecutive admissions of schizophrenic patients revealed 14 THP abusers, an incidence of 6.5%. The demographic and clinical variables of the THP abusers were compared with a randomized control group of 28 schizophrenic patients using the four-dimensional factors of the BPRS (Brief Psychiatric Rating Scale). No significant differences were found in demographic variables and comorbidity for antisocial personality disorder and other substances abuse. On admission, a trend towards more negative symptoms was detected among abusers. At discharge abusers had significantly higher mean BPRS scores and higher scores on the dimensional factor of hostile-suspiciousness. The results suggest that THP abuse is not rare among schizophrenic patients who may abuse anticholinergic agents to relieve negative symptoms and/or drug-induced Parkinsonism, or alternatively for its non-specific stimulant effects, on account of worsening of positive symptoms.