Alexander Kiderman

Mucosal [SIgA] and serum [IgG] immunologic responses in the community after a single intra-nasal immunization with a new inactivated trivalent influenza vaccine

Influenza morbidity affects entire populations, imposing an enormous burden in economic terms from working days lost. Protection afforded by current vaccines is often unsatisfactory and many individuals remain averse to injections. To counter these drawbacks, we tested an inactive intra-nasal trivalent influenza vaccine on 182 vaccinated and 92 placebo subjects in the community. On study completion 73 and 66% of the subjects were immune to the vaccines two A strains, 40% (> or=1:40) and 65% (> or=1:20) to its B strain; 30-40% demonstrated a 4x hemagglutination inhibition (HAI) titer increase; GMT titers increased 2.2-2.5x. About 50% of those initially non-immune became immune. A local antibody response to the three vaccine strains was recorded in 31-44% of vaccinees in which 57, 68 and 54% exhibited a mucosal and/or serum antibody response to the A/Johannesburg, A/Nanchang and B/Harbin strains, respectively. A higher dose (40mg) of A/Johannesburg in the vaccine did not influence response. The new vaccine was safe, without side-effects, and offered reasonable protection after one dose. It could thus play an important role in increasing enrollment into immunization programs.

A double-blind trial of a new inactivated, trivalent, intra-nasal anti-influenza vaccine in general practice: relationship between immunogenicity and respiratory morbidity over the winter of 1997–98

BACKGROUND Influenza is responsible for considerable morbidity not only among older people but in younger age groups as well. However, most large-scale anti-influenza vaccination campaigns are still aimed principally at the elderly using injectable vaccines. Until now there has been much less emphasis on targeting younger populations or using intra-nasal vaccines in mass anti-influenza immunisation programmes. OBJECTIVES To assess the immunogenicity of a new inactivated intra-nasal anti-influenza vaccine and to measure its effect on respiratory morbidity in a volunteer general practice population. STUDY DESIGN A prospective, double-blind, placebo-controlled trial using the new vaccine was carried out over the winter of 1997-98 on 274 healthy patients aged 12-60 from three Israeli general practices, 182 in the vaccine group and 92 in the placebo group. Following vaccination the changes in the antigen levels and episodes of respiratory illness in the vaccine and placebo groups were measured. RESULTS Protective antibody levels occurred after a single dose of vaccine [influenza H1N1, 41% immune pre-vaccination to 73% post-vaccination; influenza H3N2, 35-66%; influenza B, 27-64%]. Between January and March 1998, when influenza activity was at a peak in Israel, the average number of respiratory illness events in the vaccine group [14 events/100 subjects per month] was significantly less than in the placebo group [22 events/100 subjects per month]; similarly, the average number of respiratory illness days in the vaccine group over the same period [69 days/100 subjects per month] was significantly less than in the placebo group [117 days/100 subjects per month]. CONCLUSIONS The new vaccine possessed significant immunogenicity and was associated with a significant reduction in respiratory morbidity among a group of healthy older children and adults. Since intra-nasal vaccines are simpler to administer and more acceptable to the public than injections the vaccines potential for use in routine anti-influenza vaccination campaigns seems promising, especially if its beneficial effects are also reproducible in more medically vulnerable populations.

Bi-lateral eosinophilic ulcers in an infant treated with propolis.

BACKGROUND: Propolis is a natural substance, produced by the honey bee, containing amino acids, flavanoids, terpenes and cinnamic acid. It has long been used in folk-medicine for topical inflammatory conditions including ulcerative lesions of different aetiologies. METHODS: A 13-month-old female infant developed bilateral eosinophilic ulcers of the mouth, becoming the youngest patient in the literature so far reported to have done so. Following a protracted 4-month course, during which time the lesions remained unchanged despite various treatments, the ulcers were treated locally with a lanolin-based propolis ointment. RESULTS: Application of the propolis ointment was associated with the rapid resolution of the ulcers within 3 weeks and they did not subsequently recur. CONCLUSIONS: Although inevitably circumstantial, the abrupt healing of this childs chronic eosinophilic ulcers suggests that, in the light of its previously known therapeutic associations, propolis deserves further evaluation in the treatment of this condition, and perhaps in other forms of oral ulceration as well. ( J Dermatol Treat (2001) 12: 29-31)

Preventive Adolescent Health Care in Family Practice: A Program Summary

The AMA Guidelines for Adolescent Preventive Services (GAPS) has been the cornerstone of preventive care for teenagers since its publication in 1994. Despite this, there has been little documentation of their implementation in the family medicine literature. This article gives an overview of a family practice–based adolescent preventive health program based on GAPS recommendations, and reports on compliance, feasibility and health issues. A Community-Oriented Primary Care (COPC) program targeted all adolescent patients aged 12—18 years in two Israeli family practices. 321 teenagers were invited to participate. Every 7th and 10th grader was invited for a preventive health visit with the family physician and nurse. The visits included a medical evaluation, screening and counseling regarding health issues recommended by GAPS, and counseling regarding personal health concerns. Parents were also invited to meet with the staff. 184 (57%) of the adolescents invited for health visits attended. The overall visit time was 47 minutes, including 12 minutes for a questionnaire and 35 minutes with providers. Common biomedical problems included overweight, acne and dysmenorrhea. Health risk behaviors and psychosocial problems included cigarette or alcohol use, dieting, infrequent/never seat belt use, and feeling depressed. 78% wanted to discuss at least one personal health issue. 27% were invited for follow-up visits. Only 3% of the parents came for visits. A community-oriented approach facilitates bringing adolescents for preventive health visits. Many previously undetected health issues, particularly psychosocial and behavioral, are revealed during these visits. A concerns checklist aids in addressing personal health concerns.

An eye for a tooth.

OBJECTIVE To propose a possible link between dental extraction and intra-ocular complications. BACKGROUND Several publications in medical literature describe intra-ocular complications after different dental procedures. RESULTS Retinal detachment and vitreous hemorrhage following dental extraction with an appropriate anesthesia. CONCLUSION Systemic complications following dental treatments should not be neglected and proper medical treatment must be provided as soon as possible.

The effect of brushing on hair loss in women

Background: Hair loss is a common, bothersome problem among women. Objective: To evaluate the effect of different brushing frequencies on hair loss in women. Methods: This was a non-randomized crossover study. During a 4-week period, 14 women were asked to brush their hair with different frequencies during each of the 4 weeks. The amount of hairs lost during each week was counted and the average hairs lost during each week was compared with that of a week with a different brushing frequency. Results: In all comparisons analyzed, hair loss was reduced by reducing brushing frequency. A subgroup analysis found strong association (p < 0.05) between brushing frequencies and the magnitude of hair loss. A limitation of the study was that the majority of the subgroup analyses did not find a statistically significant association between brushing frequency and amount of hair lost. Conclusion: Brushing is associated with hair loss. Reducing the brushing frequencies may reduce the amount of hair shed.