Exactly 5 years ago today, Dafna Meir, a 38 year old nurse, wife, and mother of 4, was brutally murdered at her home in front of 2 of her children, by a 15 year old Palestinian.

Two days later, the murderer was arrested by Israeli security forces.

Here is his testimony >>

“She struggled”, the 15 year old murderer told the investigators.
“I stabbed her until I couldn’t pull the knife out of her body” >>
“Why did you kill her?”
he was asked by the investigators.

“Israel is killing our youths. That’s why. I decided to do the same as other young Palestinians do...I realized I might get hurt but I had faith in god” >>
“I was hiding and watching a settler lady with two small kids. She had that Jewish head scarf. She was speaking on her cellphone...I waited until she stepped outside so I can murder her” >>
“She stepped outside, I ran 5 meters towards her and stabbed her in the stomach...she began screaming...her children saw me stabbing her and began screaming”
“...I stabbed her in the chest, 3 or 4 times...she struggled, trying to grab the knife...Kids were screaming and she kept struggling...
I tried to pull out the knife, and to keep stabbing her, but the knife was stuck. So I ran. I got back home around 18:30” >>
When he got home, he joined his family watching a documentary on TV. He didn’t tell them about what he has done.
“Then I went to bed. I didn’t leave the house until they came to arrest me” >>
“If you could have pulled the knife out, what would you have done?” the investigators asked.

“I would have kept on stabbing her. And if I would’ve seen another Jew, I would have stabbed and killed him too” >>
“...I would have kept on murdering Jews until I would’ve died as a martyr”.

“Why would you have wanted to die as a martyr?”
the murderer was asked >>
“Every Muslim hopes for a martyr’s death. I want to go to heaven and get 70 virgins.” >>
“...the liberation of Palestine is in the hands of the prisoners and the Shahids and heroes. We will return to Acre, Haifa, Tiberius, Jaffa and Nazareth” >>
“If I would’ve let you go right now, what would you do?” the investigators asked.

“I would go to Al-Aqsa, and on my way, I would kill as many Jews as I could”.

May the memory of Dafna Meir and all victims of terror be a blessing.

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Why can cefepime cause neurological toxicity?

And why is renal failure the main risk factor for this complication?

The answer requires us to learn about cefepime's structure and why it unexpectedly binds to a certain CNS receptor.

#MedTwitter #Tweetorial


2/
Let's establish a few facts about cefepime:

🔺4th generation cephalosporin antibiotic
🔺Excretion = exclusively in the urine (mostly as unchanged drug)
🔺Readily crosses the blood-brain barrier (so it easily accesses the brain)

https://t.co/rjYG1BfGPR


3/
The first report of cefepime neurotoxicity was in 1999.

A patient w/ renal failure received high doses of cefepime and then developed encephalopathy, tremors, myoclonic jerks, and tonic-clonic seizures.

✅All symptoms resolved after hemodialysis.

https://t.co/u7JLVitQpp


4/
Cefepime neurotoxicity is surprisingly common, occurring in up to 15% of treated critically ill patients (w/ symptoms varying from encephalopathy to seizures).

💡The main risk factors = renal failure and lack of dose adjustment for renal function.

https://t.co/nxbnzSq8AR


5/
What about cefepime induces neurotoxicity?

One clue is that it's not the only antibiotic that causes neurotoxicity, particularly seizures.

This actually is a class effect w/ other beta-lactam antibiotics (including penicillins and carbapenems).

https://t.co/Lf4BhON9IY

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