Yulia Treister-Goltzman

Trends in publications on complementary and alternative medicine in the medical literature.

Abstract Background: Public interest in and demand for complementary and alternative medicine (CAM) services have increased in recent years throughout the Western world. The aim of the study was to assess trends in publications on CAM in the medical literature between 1963 and 2012 and to compare them with overall trends in publications on medical issues. Methods: A search of the literature was conducted on CAM and integrative medicine using the PubMed and Google Scholar search engines with key search terms. Results: Articles on CAM began to appear in the medical literature 50 years ago. Over the years there has been an increase in the number of publications. On PubMed the increase was from 15,764 to 144,288 articles from 1963 to 2012. In the decade between 1963 and 1972 publications on CAM comprised 0.81 % of all the articles appearing in PubMed. Over the course of the 50 years, the percentage increased more than twofold to 1.92 % from 2003 to 2012. On Google Scholar there were 27,170 citations related to CAM between 1963 and 1972. This increased to 2,521,430 between 2003 and 2012. Conclusions: Over the last 50 years there has been an increase in scientific publications on CAM in general, and on specific CAM treatments in particular.

Literature review of type 2 diabetes mellitus among minority Muslim populations in Israel

This review surveys the literature published on the characteristics and implications of pre-diabetes and type 2 diabetes mellitus (T2DM) for the Arab and Bedouin populations of Israel. T2DM is a global health problem. The rapid rise in its prevalence in the Arab and Bedouin populations in Israel is responsible for their lower life expectancy compared to Israeli Jews. The increased prevalence of T2DM corresponds to increased rates of obesity in these populations. A major risk group is adult Arab women aged 55-64 years. In this group obesity reaches 70%. There are several genetic and nutritional explanations for this increase. We found high hospitalization rates for micro and macrovascular complications among diabetic patients of Arab and Bedouin origin. Despite the high prevalence of diabetes and its negative health implications, there is evidence that care and counseling relating to nutrition, physical activity and self-examination of the feet are unsatisfactory. Economic difficulties are frequently cited as the reason for inadequate medical care. Other proposed reasons include faith in traditional therapy and misconceptions about drugs and their side effects. In Israel, the quality indicators program is based on one of the worlds leading information systems and deals with the management of chronic diseases such as diabetes. The programs baseline data pointed to health inequality between minority populations and the general population in several areas, including monitoring and control of diabetes. Based on these data, a pilot intervention program was planned, aimed at minority populations. This program led to a decrease in inequality and served as the basis for a broader, more comprehensive intervention that has entered the implementation stage. Interventions that were shown to be effective in other Arabic countries may serve as models for diabetes management in the Arab and Bedouin populations in Israel.

A muslim family with several members with celiac disease and other autoimmune disorders.

Abstract The Bedouin community of Israel is a traditional Muslim society. It is characterized by one of the highest rates of population growth in the world. The custom of intermarriage, especially among cousins or within the extended family, is very common because of the community’s tribal structure. The rate of genetic disease in this population is high. We present a Bedouin family in which the father suffers from celiac disease and Hashimoto’s disease, his daughter has celiac and Crohn’s disease, three other children have IgA deficiency, and a half uncle has Crohn’s disease. In describing this family we present the familial nature of these diseases, the age at diagnosis, the marital relationships of the family members and co-morbid diseases and medical conditions. Family doctors can develop and use genograms that can facilitate their understanding of the situation and enable them to develop plans for health promotion and disease prevention counseling in the community.

Erythema Ab Igne

A 30-year-old Bedouin woman who lives in a hut presented with skin changes in the anterior portion of both shins. The lesions were mildly itchy. The skin changes had developed gradually over some years and were significantly worse during winter periods. History revealed repeated sitting in front of an open fire in the hut used for warmth in winter. Physical examination (Figure 1) showed nonblanching brown lichenified hyperpigmentation in a reticular pattern on both anterior shins and ankles. Based on the findings a diagnosis of Erythema ab igne (EAI) was established. Figure 1. The rash on patients shins and ankles. Diagnosis of EAI is based on clinical history and physical examination.1 The EAI is caused by repeated exposure to heat at a lower level than that which causes a thermal burn (infrared radiation). Historically, this condition was seen in people, who sat closely to open fires. The EAI is a rare condition because of the advent of central heating. Its incidence has been rising as heating sources are being used to treat chronic pain. Currently, it is more commonly seen after repeated use of heating pads, laptops occupational exposure, and car heaters.2 Chronic lichenified lesions of EAI have potential for malignant transformation. A skin biopsy performed revealed no evidence of malignancy. Erythema ab igne may be considered an infectious disease mimic. In an era in which health care workers are increasingly being globalized and deployed to exotic locations, lesions such as in the patient presented here may be misinterpreted because of lack of awareness of certain culture practices and conditions.

Images in Clinical Medicine: McCune-Albright Syndrome

Twelve years ago, the patient on the left (Figure 1), one of the 29-year-old single-placenta monozygotic twin sisters, underwent computed tomography after a relatively mild head trauma. As an incidental finding, the computed tomography scan (Figure 2) revealed that the skull structure was consistent with fibrous dysplasia, a characteristic finding for McCune-Albright syndrome. The pituitary gland was slightly enlarged. The second twin had no features of McCune-Albright syndrome. McCune-Albright syndrome is a sporadic disorder, caused by postzygotic activating mutations of the GNAS1 gene and characterized by polyostotic fibrous dysplasia, pigmented patches of skin, and endocrinological abnormalities (1). The extent and the nature of the abnormalities are highly variable, depending on the specific tissues involved in mosaicism. The affected twin had regular menses beginning at age 13. Her zygoma was very prominent on the left side, a manifestation of fibrous dysplasia, and the facial structure was typical of acromegaly (broad nose, elongated jaw, large mandible, and sharp facial features). There was an oval-shaped hyperpigmented lesion on the lower chest. Laboratory tests revealed high levels of serum prolactin, IGF-1, and GH (without oral glucose challenge test stimulation), which led to a diagnosis of acromegaly. The levels of TSH and T4 were normal. Molecular analysis of the GNAS1 gene from both twins did not reveal the cause of the discordance. Treatment of acromegaly was initiated with a somatostatin analog and a dopamine agonist, and fibrous dysplasia was managed with bisphosphonates. Under this treatment, GH and IGF-1 stabilized at slightly increased levels. Over the years, the phenotypic features of acromegaly became more prominent.

Trends in Publications on Medical Cannabis from the Year 2000

Widespread use of cannabis as a drug and passage of legislation on its use should lead to an increase in the number of scientific publications on cannabis. The aim of this study was to compare trends in scientific publication for papers on medical cannabis, papers on cannabis in general, and all papers between the years 2000 and 2017. A search of PubMed and Web of Science was conducted. The overall number of scientific publications in PubMed increased 2.5-fold. In contrast, the number of publications on cannabis increased 4.5-fold and the number of publications on medical cannabis increased almost 9-fold. The number of publications on medical cannabis in Web of science increased even more (10-fold). The most significant number of publications was in the field of psychiatry. In the fields of neurology and cancer treatment there was a significant increase in the years 2011-2013. There was a rise in the number of publications on children and the elderly after 2013. The specific indications with the largest number of publications were HIV (261), chronic pain (179), multiple sclerosis (118), nausea and vomiting (102), and epilepsy (88). More than half of the publications on medical cannabis originated from the United States, followed by Canada. More than 66% of the publications were original studies. The spike in the number of scientific publications on medical cannabis since 2013 is encouraging. In light of this trend the authors expect an even greater increase in the number of publications in this area in coming years.

An Allergic Reaction to Henna Used in a Traditional Painting Ceremony

A 22-year-old female patient, who was born in India and immigrated to Israel, presented with itching and a raised rash on her right hand (Figure 1 ). The rash appeared a few days after the traditional henna ceremony, which was held on the day before her wedding. The patient is a healthy woman with no personal or family history of allergy or other atopic reactions. “Henna” painting is an ancient ceremony that prevails in all eastern communities and has been adopted by parts of the eastern Jewish communities. In the ceremony, a red-orange paste, which is produced from the henna plant (Lawsonia inermis), is spread on the brides and the grooms hand as a blessing for prosperity and as a sign of good luck. The henna plant grows in the hot climate of northern Africa and southwest Asia, so its use is very prevalent in those regions.1 In the community of Indian Jews, the mother of the bride traditionally rubs the henna paste onto the fingers of the right hand where the wedding ring is to be worn. Figure 1. An allergic reaction to traditional henna. It takes several hours after application of the paste until the red-brown shade materializes. Pure henna is a relatively safe product and allergic reactions to it are rare. The modern technique used to obtain a darker shade more quickly is to add p-phenylenediamine.2,3 Black henna tattoos induce contact allergy to its ingredient p-phenylenediamine at an estimated frequency of 2.5%.4 The classic allergic reaction to p-phenylenediamine is a type IV delayed-type hypersensitivity (DTH) reaction, but an acute life-threatening type I reaction has also been described.1 The manifestation of allergic dermatitis to p-phenylenediamine varies in severity from an intensely itchy erythematous, blistering eruption to painful, itchy exudative bullous eruptions, swelling, or renal collapse and failure.5 There have been reports of tattoo-induced chronic psoriasis on the tattoo sites despite treatment.5 The phenomenon reported in our patient is likely a type IV DTH response after haptenylation of host proteins. The patient was treated with topical steroid ointment with improvement in the itching and erythema. Physicians who work in tropical regions or who treat immigrants from these regions should recognize and know the spectrum of traditional customs that can cause diseases and various skin problems.

A Descriptive Analysis of Changes in Selected Drug Groups Available to Primary Care Physicians in Israel From 2000 to 2013.

Several medical and economic factors affect the process of development and introduction of new drugs and the disappearance of various medical agents from the drug market. There are no data in the existing literature on quantitative and qualitative changes in the drug market. We assessed changes in the drug market in Israel over 14 years, focusing on drug groups that, in our subjective opinion, are mainly used in primary care medicine: pain medications, lipid lowering agents, drugs for diabetes, and antihypertensives. We assessed volume of drugs and changes and trends in terms of therapeutic efficacy and safety in selected drugs in each of the groups over the study time period. We used the Medic Compendium for the analyses. Medic contains a listing of drugs that are approved and available for use in Israel. It is updated every 2 months. In 2000, there were 253 available drugs in the study groups that contained 124 active agents. In contrast, in 2013, there were 278 available drugs that contained 130 active agents. Over the study years, there was an increase in the number of drugs that are effective, “user friendly,” and have a high safety profile. Our study provides the first data on quantitative and qualitative changes that have taken place in selected groups of drugs. Although the availability of the drugs in different countries is determined by multiple factors, we assumed that there are other countries with a similar situation in terms of their drug markets.