Sociodemographic factors and the declining prevalence of anti-hepatitis A antibodies in young adults in Israel: implications for the new hepatitis A vaccines.

In order to examine changes in the epidemiology of hepatitis A virus (HAV) infection in Israel during the past decade, a sero-epidemiological study was carried out in 1989 in a random sample of 1153 members of the permanent army, aged 21-30 years. Of the males 59.2%, and 54.3% of the females were anti-HAV antibody positive (p = 0.22). At all ages, the highest prevalence was in those of North African origin, followed by those of Asian, native Israeli and Western origin. There was a marked decline in the prevalence of antibodies in later birth cohorts, (from 74.4% in those born in 1959-1960, to 47.8% in those born in 1967-1968). Age, ethnic origin, number of siblings, more than two younger siblings and smoking were independently significantly associated with anti-HAV antibodies. Despite an overall decline in family size in later birth cohorts, ethnic differences remain prominent. These findings suggest that when the new active hepatitis A vaccines become available, their use in small children should dramatically reduce the incidence of diseases in highly endemic areas by limiting intrafamilial spread of the disease.     

Burn patients'' use of autohypnosis: making a painful experience bearable

Autohypnosis (that is performing hypnosis in the absence of the therapist) was used for adjuvant analgesic and anxiolytic therapy in 18 burn patients. It combines the advantages of hypnosis without being limited by the availability of the hypnotic therapist immediately prior to painful activities. Autohypnosis is less time and labour consuming, and therefore less expensive. Out of 180 patients treated with autogenic relaxation techniques only 48 (27 per cent) entered a state of hypnosis that enabled them to cope with their pain, and 18 (10 per cent) achieved autohypnosis. Most of these patients needed some auxillary devices such as recorded instructions or telephone calls.     

Genetic studies in a family with inverted nipples (mammillae invertita)

A Jewish Sephardi family is reported in which 16 members are affected (15 females and 1 male) with inverted nipples. The one affected male and his brother also have gynecomastia. Under the assumption that this trait is transmitted as an autosomal dominant, linkage studies were done but were not revealing. Further family and investigative studies are needed in this disorder to understand better its pathogenesis and precise mode of genetic transmission.     

Fetal exposure to isotretinoin-an international problem

BACKGROUND: Isotretinoin is a known teratogen. Pregnancy prevention programs aimed at minimizing isotretinoin exposure in pregnancy have been implemented in North America with limited success. OBJECTIVE: To compare the management of fetal risk of isotretinoin in three countries, including information given to women, implementation of contraceptive methods, and pregnancy outcomes. METHODS: Pregnant women exposed to isotretinoin who called teratogen information services (TIS) in Israel, Italy and Canada between July 1998 and October 2006 were interviewed at the time of initial consultation and after the expected day of delivery. RESULTS: Fifty-three pregnant women exposed to isotretinoin contacted the TIS. Only 41% reported using a birth control method. Just one patient reported using two different forms. Forty-five percent of exposed pregnancies were terminated before delivery and 22% delivered healthy babies. Two babies were born with malformations. CONCLUSIONS: Since isotretinoin-exposed pregnancies still occur, there is a need for more effective strategies, which should take into account the cultural differences.     

Need for endotracheal intubation and suction in meconium-stained neonates

In a prospective study, we determined whether routine immediate tracheal aspiration at birth is necessary in meconium-stained but otherwise normal infants delivered vaginally and having a 1-minute Apgar score greater than 8. A total of 572 newborn infants who met these criteria were randomly allocated to one of two groups. All infants underwent oropharyngeal suctioning with a DeLee catheter while the head was still on the perineum. In group I (n = 308) suctioning of the trachea under direct vision was performed instantly at birth; in group II (n = 264) this procedure was not done. There was no mortality among infants in the study, but morbidity, mainly pulmonary and laryngeal disorders, occurred in six of 308 group I infants and in none of the group II infants (P less than 0.025). Immediate tracheal suction is not a harmless intervention, and should be considered superfluous in a vigorous term neonate born with meconium-stained amniotic fluid.     

Hypermobility spectrum disorders and active migraine in Israeli adolescents: A nationwide study

Objective

To assess the association between hypermobility spectrum disorders/hypermobile type Ehlers Danlos Syndrome (HSD/hEDS) and migraine in a national sample of adolescents in Israel.

Background

The association between HSD/hEDS and migraine is unclear, even more so in pediatric populations.

Methods

This population-based, cross-sectional study included 1,627,345 Israeli adolescents (945,519/1,626,407 [58%] males; mean age 17 ± 0.5 years) who were medically assessed before mandatory military service during 1998–2020. Diagnoses of migraine with at least one attack per month (active migraine) and HSD/hEDS were confirmed by certified specialists. The prevalences of active migraine in adolescents with and without HSD/hEDS were computed and the association between HSD/hEDS and active migraine was examined.

Results

Active migraine was significantly more prevalent in adolescents with HSD/hEDS (307/4686 [6.5%]) compared to those without HSD/hEDS (51,931/1,621,721 [3.2%]) (OR = 2.16, 95% CI 1.90–2.45). The association between HSD/hEDS and active migraine persisted in a multivariable analysis (OR = 2.08, 95% CI 1.85–2.34) and in several sensitivity analyses.

Conclusions

We found a significant association between HSD/hEDS and active migraine in both male and female adolescents. Clinical awareness of the association can promote early diagnosis and treatment of migraine. Further research is required to identify appropriate pharmacologic and nonpharmacologic migraine treatment strategies for individuals with HSD/hEDS.