health  &  wellness 

Cold...Influenza Vaccine & Treatment?

In the Cold season the recommendation is for the Vaccine against the Influenza Virus, for people at high risk: the elderly, the pregnant, adults and children with chronic diseases, children and teenagers who are receiving long-term aspirin. Vaccination being a preventive measure that is cheaper than treatment.

Influenza virus causes a respiratory infection that can range from no symptoms to the typical cold to pneumonia to even death in high risk people. For the treatment  of the virus, Glaxo-Wellcome had introduced Relenza: Zanamivir an inhaled medication (similar to Tamiflu: Oseltamivir  by Hoffmann La Roche). Some studies have shown that it may also prevent transmission of the virus to others, in general with mild side effects.
Reference
 · Stamboulian D - Infect Dis Clin North Am - 2000 Mar; 14(1): 141-66
From NIH/NLM MEDLINE, HealthSTAR 
 ·  Neuraminidase inhibitors for treatment of influenza A and B infections [published erratum appears in MMWR Morb Mortal Wkly Rep 1999 Dec 17;48(49):1139]

The Abortion Pill …..RU- 486

The "Abortion Pill" also known as RU- 486 (or mifepristone and Mifeprex ® ), and its follow up medication misoprostol, can terminate unwanted pregnancy earlier than most surgical procedures. Among the complications reported by women were excessive bleeding, cramping, nausea and diarrhea; Patients with bleeding disorders and those who smoke are among the patients that should avoid RU-486. A rare reported complication was toxic epidermal necrolysis after mifepristone/gemeprost-induced abortion.

The "Pill" may require three office visits. The first visit is to confirm that the pregnancy is in the uterus, and that it is within the time period allowed by law to take the pill. The second visit is to take the follow-up drug, which triggers contraction of the uterus and expulsion of fetal tissue. The third visit is to confirm that the abortion was successful. The patients will have 35 days from the date of their first missed period to make the necessary arrangements.

According to the conclusion of "one" study from India, China and Cuba, the "Pill" failure rate although low, exceeds surgical procedures, and the "Pill" may be safe efficacious and acceptable in developing countries.
Reference
· Safety, efficacy, and acceptability of medical abortion in China, Cuba, and India: a comparative trial of mifepristone-misoprostol versus surgical abortion. Winikoff B et al. - Am J Obstet Gynecol - 1997 Feb; 176(2): 431-7
From NIH/NLM MEDLINE, HealthSTAR
· Toxic epidermal necrolysis after mifepristone/gemeprost-induced abortion
C. Lecorvaisier-Pieto MD et al. Journal of the American Academy of Dermatology
Volume 35 • Number 1 • July 1996, Copyright © 1996 American Academy of Dermatology, Inc.

Stress worsens Heart disease and decreases Immunity
 
How someone deals with stress affects their health and work. Prolonged stress showing up in continuous anxiety, fear, sadness and anger leads to feeling tired and having difficulty working effectively, this may contribute to illness, and some have suggested that stress may affect the immune system. Stress such as caring for a spouse with dementia, and experiencing marital discord, and grieving have been shown to affect the immune function. There is some evidence that chronic anger and hostility are risk factors for heart disease.

One study in patients with heart disease having "balloon opening of heart arteries" (Angioplasty), looked at levels of hostility (anger/hate) in these patients and found that the ones who were most hostile, were more likely to undergo a repeat balloon procedure (Angioplasty) than those who were less hostile. This may suggest that people with hostile/angry personalities may be at higher risk for heart disease.

Another study showed similar results, stressed individuals showed sharp and significant increases in blood pressure, heart rate and blood thickness (viscosity). These studies suggest that stress and anger may contribute to heart disease, but the relationship is not clearly established.
Reference
·  Irwin M, Lacher U, Caldwell C: Depression and reduced natural killer cytotoxicity: A longitudinal study of depressed patients and control subjects. Psychol Med 22(4):1045-1050, 1992
·  Kiecolt-Glaser J, Dura JR, Speicher CE, et al: Spousal caregivers of dementia victims: Longitudinal changes in immunity and health. Psychosom Med 53(4):345-362, 1991
·  Kiecolt-Glaser JK, Fisher LK, Ogrocki P, et al: Marital quality, marital disruption, and immune function. Psychosom Med. 49(1):13-34, 1987
·  Calabrese JR, Kling MA, Gold PW: Alterations in immunocompetence during stress, bereavement, and depression: Focus on neuroendocrine regulation. Am J Psychiatry. 144(9):1123-1134, 1987
·  Irwin M, Daniels M, Risch SC, et al: Plasma cortisol and natural killer cell activity during bereavement. Biol Psychiatry 24(2): 173-178, 1988
·  Zisook S, Shuchter SR, Sledge PA, et al: The spectrum of depressive phenomena after spousal bereavement. J Clin Psychiatry. 55:29-36, 1994
·  Goodman M, Quigley J, Moran G, et al: Hostility predicts restenosis after percutaneous transluminal coronary angioplasty. Mayo Clinic Proc 71(8):729-734, 1996
·  Muldoon MF, Herbert TB, Patterson SM, et al: Effects of acute psychological stress on serum lipid levels, hemoconcentration, and blood viscosity. Arch Intern Med. 155(6):615-620, 1995

Reducing the risk of meningitis during the Hajj to Mecca

Two million pilgrims from more than 140 countries, go every year to Saudi Arabia for pilgrimage to Mecca and the holly places of Islam, in what is known as the "Hajj". In the "Hajj" of March 2000, health officials in Saudi Arabia identified an outbreak of meningitis (meningococcal), which is a bacterial infection in the area of the brain.
Four cases of the disease were identified among the estimated fifteen thousand pilgrims returning to the United States and their close contacts and community. Approximately 400 cases of the same disease were identified worldwide during 2000. Whether an outbreak of meningococcal disease will recur in 2001 is not known.
After an outbreak of meningitis in the "Hajj" of 1987, Saudi Arabia required all pilgrims to receive the vaccine (meningococcal polysaccharide vaccine). However, vaccination does not protect against the people that carry (carriers) the bacteria in their nose and throat, and are not sick themselves from it. "Carriers" of the bacteria, may transmit the infection to people they come in close contact with, upon their return from Saudi Arabia, therefore, taking an antibiotic can reduce the risk of transmission and disease.

Refererece
Journal of the American Medical Association: March 21, 2001
Hajj: Health and Vaccination requirements

 edited by: Tammam Farhat, MD & Nizar Eskandar, MD -  2001