[50th anniversary of the Israel Defence Forces Medical Corps].
Explore the source record for details and available documents.
Humans↗
Biomedical subjects
A Eldad
Publications and source records attributed to A Eldad.
Measles epidemic in Israel-successful containment in the military.
BACKGROUND: Measles vaccination at ages 12-15 months is a routine part of standard health care in developed countries. Nonetheless, the prevention and control of measles outbreaks remain a challenge, owing to incomplete or variable compliance with immunization programs and primary vaccine failure (approximately 5%). In Israel, vaccination coverage against measles is high, yet sero-epidemiological studies conducted in the early 1990s showed that 15% of 18-year-olds were unprotected. METHODS: 1994 there was a countrywide epidemic of measles, which spread to the military. The Israel Defense Forces Medical Corps immediately launched a wide-scale vaccination campaign, targeting primarily field units and training bases, where crowded living conditions are the rule. RESULTS: The immunization campaign led to an abrupt cessation of morbidity in the military. In the civilian sector, where no intervention was undertaken, the epidemic continued for another 4 months. CONCLUSIONS: Institutional measles outbreaks, especially in the presence of crowded conditions or high contact rates, may be effectively controlled by mass vaccination.
Incidence↗
Periodontal status by CPITN, and associated variables in an Israeli permanent force military population.
AIMS: The objectives were to determine periodontal treatment needs using the CPITN index, of Israeli permanent force military personnel. METHODS: The study population consisted of 1300 military personnel aged 25-44 years (mean age 33.8 +/- 5.4), who attended obligatory routine medical and dental examinations. Clinical examinations were conducted by 3 calibrated examiners, employing flat dental mirrors, the specially designed WHO periodontal probes (FDI probes) and following CPITN criteria. The frequency distributions were studied with regard to age groups, gender and education, as well as differences in the severity of the disease. Also, the mean number of sextants affected per person by age was assessed. RESULTS: Only 1.19% of the subjects demonstrated healthy periodontal tissue. Shallow pockets were similarly found among all age groups, and the number of persons with deep pockets increased with age. Deep pockets were found almost 3 x more among males (18.66%) in comparison with females (6.19%). Persons with higher education (> 12 years), had less deep pockets and bleeding than individuals with less than 12 years of education (p<0.05). CONCLUSIONS: Compared with data from other countries reported by the WHO, this periodontal status indicates a relatively high level of treatment needs. This survey provides a substantial contribution to the national oral health data bank concerning the adult working population in Israel.
Adult↗
Trends in caries and associated variables among young Israeli adults over 5 decades.
This study was conducted among a representative sample of 7,139 21-year-old Israeli adults, upon release from compulsory military service. Data were collected between 1994 and 1997. The average DMFT level found was 8.49+/-4.95. Untreated caries (according to the D component of DMFT) was 2.25+/-2.90 and significantly higher among males. Untreated caries was also significantly associated with geographic origin: higher among subjects of African or former USSR descent; and with family size: higher among subjects with four or more siblings; with education: caries was higher among subjects with less than 12 years of schooling; and with smoking: caries was more extensive among those who smoked (P<0.0001 for all the associations). Caries severity (DMFT) was found to be significantly associated with father's country of origin and number of siblings (highest among subjects of Asian and African descent and those who had four or more siblings). This is the largest and most representative Israeli survey of young adults to date. Data were compared with available data from studies conducted in 1956, 1966, 1973, and 1985. DMFT scores had previously increased from the 1950s until the 1980s. Treatment levels had increased since the 1980s. The present data, together with results of studies conducted among Israeli children, indicate a recent national decrease in caries experience. This study indicates a further increase in caries treatment level, but a persisting inequity according to social variables.
Adult↗
Does immune serum globulin confer protection against skin diseases?
BACKGROUND: Following a case of serologically proven hepatitis A in a food-handling worker serving several military bases in the same vicinity, the entire military population was vaccinated with immune serum globulin (ISG). OBJECTIVE: To evaluate the effectiveness of ISG in preventing skin disease. METHODS: The data for this study were drawn from the military archives of the Medical Corps. The population of the bases was followed for a period of 3 months after immunization. Rates of selected skin diseases were compared with those of a nearby base during the same period, and with those in the population of the same bases a year earlier. RESULTS: The rates of several skin diseases (bacterial skin infections, dermatitis and eczema, fungal infections, acne, warts, nail disorders, and nonspecific skin diseases) among the vaccinated population were significantly lower when compared to the historical control group and to the contemporary control group of the nearby base. CONCLUSIONS: ISG provides a protecting effect for skin diseases, especially those of infectious origin.
Adolescent↗
Preliminary experience with postmortem computed tomography in military penetrating trauma.
BACKGROUND: Postmortem examination serves as a tool for confirmation of clinical diagnosis, "quality" assurance, and education. In Israel, mostly because of religious reasons, most families withhold their permission to perform autopsies. To obtain objective information regarding the death of soldiers, the Israel Defense Forces Medical Corps started in September of 1997 to perform postmortem computed tomographic (PMCT) scans. The purpose of our study is to determine what information can be obtained from the PMCT scans. METHODS: In a period of 16 months, 27 soldiers were killed in low-intensity conflicts and PMCT was obtained in 22 cases. Medical data obtained from the field medical care providers were collected and compared with PMCT results. RESULTS: Several examples of patients whose death was determined at the scene either before any medical intervention or after initiation of resuscitative treatment are shown in our study and compared with the clinical impression of the treating physician. Two examples of autopsy results are compared with PMCT results. Gas was detected in various parts of the circulatory system in many cases. The significance of this finding, described in our study for the first time, needs further investigation. CONCLUSION: PMCT scanning has limits in detecting superficial injuries and injuries of the extremities and determining the exact route of fragments through body tissues in penetrating military trauma. It also cannot serve as a tool for examining ammunition or the protection provided by various armors. However, it can provide a substantial amount of evidence that, when reviewed with the clinical information obtained from the physician at the scene, can help in assessing the treatment given at the field and point toward the probable cause of death.
Adolescent↗
Safety and immunogenicity of two different lots of the oral, killed enterotoxigenic escherichia coli-cholera toxin B subunit vaccine in Israeli young adults.
Enterotoxigenic Escherichia coli (ETEC) is one of the leading causes of diarrhea among Israeli soldiers serving in field units. Two double-blind placebo-controlled, randomized trials were performed among 155 healthy volunteers to evaluate the safety and immunogenicity of different lots of the oral, killed ETEC vaccine consisting of two doses of whole cells plus recombinantly produced cholera toxin B subunit (rCTB). The two doses of vaccine lot E005 and the first dose of vaccine lot E003 were well tolerated by the volunteers. However, 5 (17%) vaccinees reported an episode of vomiting a few hours after the second dose of lot E003; none of the placebo recipients reported similar symptoms. Both lots of vaccine stimulated a rate of significant antibody-secreting cell (ASC) response to CTB and to colonization factor antigen I (CFA/I) after one or two doses, ranging from 85 to 100% and from 81 to 100%, respectively. The rate of ASC response to CS2, CS4, and CS5 was slightly lower than the rate of ASC response induced to CTB, CFA/I, and CS1. The second vaccine dose enhanced the response to CTB but did not increase the frequencies or magnitude of ASC responses to the other antigens. The two lots of the ETEC vaccine induced similar rates of serum antibody responses to CTB and CFA/I which were less frequent than the ASC responses to the same antigens. Based on these safety and immunogenicity data, an efficacy study of the ETEC vaccine is under way in the Israel Defense Force.
Administration, Oral↗
The fitness-for-work evaluation of a young patient with essential thrombocythemia.
We describe a case of a military cadet, a candidate for submarine service, who was diagnosed with essential thrombocythemia (ET). The estimated risk in the literature for major clinical complications in ET patients is about 5-20%. Our report concerns a young asymptomatic patient where the estimated risk is probably much lower. We think that the activity in the marine corps, which at times is involved with some degree of dehydration, might increase the risk for thromboembolic events. The possibility of a major thromboembolic complication occurring at sea could complicate and endanger the patient's life, especially when an evacuation to a hospital is required. A submarine officer has a responsibility to other people's life who depend on his skills and ability. In case of a major complication which can cause sudden incapacitation, the consequences can be catastrophic to many. Opposed to the considerations to disqualify the young cadet stands the fact that his training was expensive, and that it would be unfortunate to disqualify a very talented young person. We thus recommended to clear the cadet as a marine officer in teaching jobs, in sites were medical assistance is available in a short period of time. In our opinion he should be disqualified from serving in combat jobs where there is a greater risk for him and for the men under his command.
Adolescent↗
Treatment of traumatic bleeding with recombinant factor VIIa.
Surgical intervention failed to stop life-threatening bleeding caused by injury complicated by severe coagulopathy. Administration of recombinant factor VIIa immediately corrected the coagulopathy and bleeding stopped.
Adult↗
[The rational and reality: between chaos and utopia].
Explore the source record for details and available documents.
Emergency Medical Services↗
Prevention of stress fractures using custom biomechanical shoe orthoses.
In a prospective study of stress fractures the hypothesis that training with custom made biomechanical shoe orthoses could lessen the incidence of stress fractures in infantry recruits was tested. Recruits were assigned randomly to groups and given soft biomechanical orthoses or semirigid biomechanical orthoses and compared with a control group that did not train in biomechanical orthoses. All recruits wore infantry boots with soles designed like those of basketball shoes. Recruits were examined biweekly during 14 weeks of basic training. The incidence of stress fractures was 15.7% for the recruits with the semirigid biomechanical orthoses, 10.7% for the recruits with the soft biomechanical orthoses, and 27% for the control group. The soft biomechanical orthoses were tolerated better by the recruits than were the semirigid devices. Among trainees at high risk for stress fractures, prophylactic use of custom made biomechanical orthoses may be warranted.
Adult↗
Prehospital blood transfusion in prolonged evacuation.
BACKGROUND: Prehospital blood transfusion for hemorrhaging trauma patients has been used infrequently and is controversial. Currently, there is no satisfactory nonsanguineous fluid therapy for use during prolonged transport, such as in military or rural trauma. METHODS: We retrospectively reviewed prehospital data and hospital charts of all trauma patients in Israel who had received prehospital blood transfusion during a period of 30 months. RESULTS: Forty patients received 60 U of Rh-positive type O packed red blood cells. Mean time from injury to hospital admission was 120 minutes. Twenty-one of 31 patients admitted to the hospital alive (68%) received additional blood transfusions during the initial resuscitation phase, justifying the prehospital transfusion. Of nine documented admissions with hemoglobin of less than 7 g/dL, one patient died of exsanguination. There was one case of a minor adverse reaction that could be attributed to prehospital transfusion. CONCLUSION: Prehospital blood transfusion is justified in certain trauma patients, especially when long prehospital transport is required. Blood may be safely maintained and used by physicians with little experience in care of major trauma.
Adolescent↗
The prevalence and treatment of dental caries among Israeli permanent force military personnel.
A survey was conducted to determine dental caries prevalence and treatment among 1,095 25- to 44-year-old permanent force Israeli military personnel. Caries experience, by decayed, missing, and filled permanent teeth (DMFT), was 11.66, with an average of 1.37 untreated caries, 2.40 extracted teeth, and 7.90 treated teeth. Caries was positively associated with age (p < 0.001). Females demonstrated statistically higher DMFT levels than males (p = 0.009). Negative associations were detected for education levels and untreated and extracted components (p < 0.001), and a positive association was detected for the treated caries component (p < 0.001). Permanent military personnel treated by private dentists exhibited 17.6% untreated caries, compared with 9.4% among personnel treated in the army. Officers had lower levels of untreated caries (8.6%) than others (13.3%). Among the present population, 77% had attended a dental clinic in the preceding 2 years. Permanent force personnel are offered free, comprehensive, and accessible dental treatment. The data emphasize a need for further dental health education.
Adult↗
Behavior of dental phobic residents of large and small communities.
The purpose of the present study was to characterize differences among dental phobic patients in past dental experience between residents of standard metropolitan areas (SMSA), and non-SMSA. Over a period of 1 year, the records of 41 dental phobic patients were evaluated. These patients were attending a special Israeli Defense Force clinic designed to treat dental phobics. The mean time since the last routine visit in both groups was 12.42 +/- 6.54 years and the mean age at which the patients had had their last routine dental treatment was 14.56 +/- 4.62 years. Over a two-year period prior to the present visit, the main reason for SMSA patients to seek any dental care was dental pain (P = 0.015). All other variables that compared the dental behavior of SMSA patients with non-SMSA patients showed no difference. The findings suggest that the availability of dentists in the SMSA did not increase the seeking of dental care. The fact that SMSA residents were more likely to seek care because of pain suggests that residents of non-SMSA areas were more likely to tolerate pain without seeking care. These findings underscore the need for proper behavioral and pain management during childhood.
Adult↗
[Burns in children in Israel--epidemiology, prevention and treatment].
45% of all hospitalized burn casualties in Israel are children younger than 16 years old. In various hospitals they make up 30-60% of all burn casualties, depending on the proportion of children in the area of hospital intake, social and economic factors and the type of hospital. Length of hospitalization of children is shorter than that of the general population (7.3 vs 9.0 days). Scalding is the main cause of thermal injuries among babies and infants (70%), while fire burns are the most common causes among adolescents (56.5%); 90% of babies are injured at home; only 40% of adolescents are burned in home accidents. In Israel, burned children are treated in 25 different hospitals and in departments of pediatric surgery, plastic surgery, general surgery, pediatrics or burn departments. There is no pediatric burn unit in Israel.
Adolescent↗
Secular trends in the epidemiology of major infectious diseases among Israeli soldiers.
BACKGROUND: Army personnel, albeit in general young and healthy, are at greater risk for infectious morbidity owing to higher crowding, compromised hygienic conditions, and exposure to new geographic and climatic factors. We describe the changing trends in the incidence of major infectious diseases of public health importance in the Israeli military: hepatitis A, measles, meningococcal disease, and diarrheal diseases. METHODS: Departments of Epidemiology and Medical Statistics of the Israel Defense Forces Medical Corps monitor the incidence of infectious diseases within the military. Notifiable diseases are predefined and their reporting is mandatory. RESULTS: The incidence of hepatitis has declined significantly since the introduction of prophylaxis with immune serum globulin in the 1970s, and complete control of outbreaks has been achieved. Outbreaks of diarrheal diseases have decreased, probably as a result of intensive control measures begun in the last decade. However, sporadic diarrheal morbidity continues to rise. The vaccination of recruits against Neisseria meningitidis was begun in 1994, following an increase in cases caused by serogroup C bacteria. So far, the program has proved efficacious in reducing morbidity. Measles morbidity in the military was much higher than in the civilian sector over the years. It has become negligible since 1995, when the first cohorts with 2 vaccination doses began their service. CONCLUSION: Despite improvements in personal and environmental health measures, immunization remains the most efficient means for preventing infectious diseases in the military.
Adult↗
Superoxide dismutase (SOD) for mustard gas burns.
Mustard gas (MS) has been used in chemical warfare since World War I. The blistering skin lesions are slow to heal. Secondary inflammation might occur, as well as damage to organs distant from the original wound. Presently there is no specific antidote for burns and poisoning by MS. This study examined treatment modalities with free oxygen radical scavengers, copper-zinc, and manganese superoxide dismutase (SOD), for MS skin burns in an experimental guinea pig model. Each of the SOD compounds reduced dramatically burn lesion area when administered intraperitoneally/intralesionally (i.p./i.l.) before wound infliction. The protective action of the SODs was also evident in the significantly higher histopathological score of biopsies obtained on day 7 from local tissue, caused with the lower dose of MS. When the SOD compounds were administered i.p. 1 hour after burn infliction, and repeated daily for 7 days, no protective effect could be detected under the present experimental conditions.
Animals↗
Early nonsurgical removal of chemically injured tissue enhances wound healing in partial thickness burns.
Chemical burns are slow healing injuries and their depth is difficult to assess. Tissue destruction continues as long as active material is present in the wound site. The routine therapy for treatment of full thickness chemical burns is early excision; it shortens hospitalization and reduces morbidity. However, presently there is no specific treatment for chemical burns of partial thickness. This study examined several treatment modalities for partial thickness chemical burns: surgical excision; laser ablation and chemical debridement with Debridase or trypsin-linked to gauze. Chemical burns were inflicted with nitrogen mustard (NM -- a nitrogen analog to sulfur mustard -- mustard gas) in an experimental guinea pig model. Debridase was most effective and reduced significantly lesion area of burns after 'humid' exposure to 2 mg NM. The healing action of Debridase was also evident in the significantly higher histopathological score of biopsies from local tissue obtained on day 5. Laser ablation was most effective and accelerated healing of burn lesions after 'dry' exposure to 5 mg NM. The histopathology score of the laser treated burns was higher on day 4 compared to untreated controls. It is concluded that for partial thickness chemical burns early nonsurgical removal of the damaged tissues accelerates wound healing.
Administration, Topical↗