Vaccination for your parents / grand parents !

The best gift to your grandparents is to get them vaccinated if they have not been vaccinated earlier.

• Annual influenza or flu vaccine is recommended for all persons aged 6 months and older.
• Pneumonia vaccine should be given to all adults aged 65 years and older.
• Tetanus Toxoid should be given to all irrespective of age after every 10 years.
• A single dose of herpes zoster vaccine is recommended for adults aged 60 years and older regardless whether they have had a previous episode of herpes zoster. The vaccination begins at 60 years of age.
• Hepatitis B vaccine should be given to all if they have not been vaccinated earlier.
• All diabetics aged 60 years or older should be vaccinated for hepatitis B. This recommendation is based on increased need for associated blood glucose monitoring in long term care facilities.
• All patients with chronic liver diseases should also be given the Hepatitis B vaccine.

Source

Rhinology. 2011 Aug;49(3):272-80. doi: 10.4193/Rhin.

Therapeutic Index (TIX) for intranasal corticosteroids in the treatment of allergic rhinitis.

Schafer T, Schnoor M, Wagenmann M, Klimek L, Bachert C.

Source

Practice for Dermatology and Allergy, Immenstadt, Germany. info@hautarzt-immenstadt.de

Abstract

BACKGROUND:

Intranasal corticosteroids (INS) are the first line treatment for allergic rhinitis (AR). To guide clinical decision-making, we created a therapeutic index (TIX) for INS reflecting efficacy and safety.

METHODS:

A Medline search (1966 to June 2009) was carried out to identify all placebo-controlled randomized trials, and observational reports for safety issues, with Dexamethasone, Budesonide (BUD), Fluticasone propionate (FP), Fluticasone furoate (FF), Flunisolide, Mometasone furoate (MF), Triamcinolone (TRIAM), and Beclomethasone dipropionate (BDP) as treatment for AR. Data on three efficacy (nasal symptoms, ocular symptoms, global assessment) and three safety outcomes (epistaxis, growth, systemic ocular effects) were extracted. Meta analyses were performed for each INS and outcome and results were categorised into scores by quartiles. Scores of the three efficacy and safety outcomes were summed up to create summation scores for efficacy (ES) and side effects (AES), respectively with a maximum of 9 points. The TIX was then defined as the ratio of ES and AES.

RESULTS:

Data of 84 studies were extracted. Based on availability of data, a TIX was calculated for 6 substances. BUD showed the highest efficacy score followed by MF and TRIAM. The lowest scores for side effects were achieved by MF and TRIAM followed by FP. These findings resulted in TIX scores of 7 and 5 for MF and TRIAM, respectively, indicating a high efficacy and low potential of adverse events. Medium scores were reached by BUD and FP and lower scores by BDP and FF.

CONCLUSION:

Although safety and efficacy is proven for all available INS by multiple studies, the systematic aggregation and analysis of data allows for a differentiated summary on clinically important features.

Source

Comment: We had published an earlier post about safety of Intranasal steroids in Allergic Rhinitis in kids (link )

This study suggests that while both Mometasone & Fluticasone Furoate may be safe in children above 2 years, MF is more likely to be effective given its higher therapeutic index. 

Best practices for children (& adults) wearing Contact Lens

What are some rules for safe contact lens wear? First, contact lenses should only be used to correct the patient's vision and not as a costume or for a decoration. They need to be fitted by a professional -- an optometrist, ophthalmologist, or optician -- who is skilled and licensed in the fitting of contact lenses. The lens should be one that has been approved by the FDA for use in humans. The lenses need to be fitted properly and the patient needs to be instructed on the proper technique for insertion, wearing, sterilization, and cleansing of the lens and storage case. Finally, those rules have to be followed carefully.

Lenses should never be worn overnight. Other high-risk use of lenses would be wearing lenses for swimming or other activities in which water or contamination would be splashed into the eyes. If a child or an adult has a red eye or a painful episode related to contact lens use, the lens should be removed immediately and the patient, along with the lens, should be sent immediately to an emergency room or, on the same day, to an eye professional to be evaluated for possible infection and started on treatment.

Those are some of the rules for safe contact lens use, but I would strongly advise that no decorative or purely cosmetic, costume contact lenses ever be used or be considered safe unless they are fitted by a professional.

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