Volume 5, Issue 5, May 19, 2017

Archives of Integrative Clinical Practice
Volume 5, Issue 5, May 19, 2017

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Early Intervention and Treatment for Age-Related Macular Degeneration

March 31, 2014
Journal of internal medicine

TAKE-HOME MESSAGE

  • In this review article, the authors describe some of the systemic vascular and inflammatory pathways and genetic factors that may underlie the pathology of age-related macular degeneration (AMD) as well as some of the potential systemic side effects of ocular AMD therapy that clinicians should consider.
  • AMD may be an ocular manifestation of systemic processes.

Abstract

Age-related macular degeneration (AMD) is a common vision-threatening condition affecting the elderly. AMD shares common risk factors and processes, including vascular and inflammatory pathways, with many systemic disorders. Associations have been reported between AMD and hypertension, cardiovascular disease, cerebrovascular disease, dyslipidaemia, chronic kidney disease and neurodegenerative disorders. An increasing amount of evidence suggests that individuals with AMD are also at risk of systemic diseases such as stroke. In this review we summarize the latest evidence to support the notion that AMD is an ocular manifestation of systemic disease processes, and discuss the potential systemic side effects of ocular AMD therapy of which general physicians should be aware. Recent genetic discoveries and understanding of the pathogenic pathways in AMD in relation to systemic disorders are also highlighted.

Journal Abstract
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Radiosteriometric analysis of movement in the sacroiliac joint during a single-leg stance in patients with long-lasting pelvic girdle pain

Clin Biomech (Bristol, Avon). 2014 Apr;29(4):406-11. doi: 10.1016/j.clinbiomech.2014.02.002. Epub 2014 Feb 16.

Kibsgård TJ

Abstract
BACKGROUND:
Chamberlain’s projections (anterior-posterior X-ray of the pubic symphysis) have been used to diagnose sacroiliac joint mobility during the single-leg stance test. This study examined the movement in the sacroiliac joint during the single-leg stance test with precise radiostereometric analysis.

METHODS:
Under general anesthesia, tantalum markers were inserted into the dorsal sacrum and the ilium of 11 patients with long-lasting and severe pelvic girdle pain. After two to three weeks, a radiostereometric analysis was conducted while the subjects performed a single-leg stance.

FINDINGS:
Small movements were detected in the sacroiliac joint during the single-leg stance. In both the standing- and hanging-leg sacroiliac join, a total of 0.5 degree rotation was observed; however, no translations were detected. There were no differences in total movement between the standing- and hanging-leg sacroiliac joint.

INTERPRETATION:
The movement in the sacroiliac joint during the single-leg stance is small and almost undetectable by the precise radiostereometric analysis. A complex movement pattern was seen during the test, with a combination of movements in the two joints. The interpretation of the results of this study is that, the Chamberlain examination likely is inadequate in the examination of sacroiliac joint movement in patients with pelvic girdle pain.

Copyright © 2014 Elsevier Ltd. All rights reserved.

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What interventions improve walking ability in neurogenic claudication with lumbar spinal stenosis?

Eur Spine J. 2014 Jun;23(6):1282-301. doi: 10.1007/s00586-014-3262-6. Epub 2014 Mar 15.

Ammendolia C1, Stuber K, Tomkins-Lane C, Schneider M, Rampersaud YR, Furlan AD, Kennedy CA.
Author information
Abstract
PURPOSE:
To investigate what interventions can improve walking ability in neurogenic claudication with lumbar spinal stenosis.

METHODS:
We searched CENTRAL, Medline, EMBASE, CINAHL and ICL databases up to June 2012. Only randomized controlled trials published in English and measuring walking ability were included. Data extraction, risk of bias assessment, and quality of the evidence evaluation were performed using methods of the Cochrane Back Review Group.

RESULTS:
We accepted 18 studies with 1,220 participants. There is very low quality evidence that calcitonin is no better than placebo or paracetamol regardless of mode of administration. There is low quality evidence that prostaglandins, and very low quality evidence that gabapentin or methylcobalamin, improves walking distance. There is low and very low quality evidence that physical therapy was no better in improving walking ability compared to no treatment, oral diclofenac plus home exercises, or combined manual therapy and exercise. There is very low quality evidence that epidural injections improve walking distance up to 2 weeks compared to placebo. There is low- and very low-quality evidence that various direct decompression surgical techniques show similar significant improvements in walking ability. There is low quality evidence that direct decompression is no better than non-operative treatment in improving walking ability. There is very low quality evidence that indirect decompression improves walking ability compared to non-operative treatment.

CONCLUSIONS:
Current evidence for surgical and non-surgical treatment to improve walking ability is of low and very low quality and thus prohibits recommendations to guide clinical practice.

PMID: 24633719 DOI: 10.1007/s00586-014-3262-6

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Myofascial trigger points in patients with whiplash-associated disorders and mechanical neck pain

Pain Med. 2014 May;15(5):842-9. doi: 10.1111/pme.12429. Epub 2014 Mar 18.

Castaldo M, Ge HY, Chiarotto A, Villafane JH, Arendt-Nielsen L.

Abstract
OBJECTIVE:
The aim of this study was to investigate pain patterns and the distribution of myofascial trigger points (MTPs) in whiplash-associated disorders (WADs II and III) as compared with mechanical neck pain (MNP).

METHODS:
Manual examination of suboccipital, upper trapezius, elevator scapula, temporalis, supraspinatus, infraspinatus, deltoid, and sternocleidomastoid muscles, was done to search for the presence of both active or latent MTPs in 49 WAD patients and 56 MNP patients. Local pain and referred pain from each active MTP was recorded on an anatomical map.

RESULTS:
The mean number of active MTPs was significantly greater in the WAD group (6.71 ± 0.79) than in the MNP group (3.26 ± 0.33) (P < 0.001), but this was not found for the latent MTPs (3.95 ± 0.57 vs. 2.82 ± 0.34; P > 0.05). In the WAD group, the current pain intensity (visual analogue scale) of the patients was significantly correlated with the number of active MTPs (rs  = 0.03, P = 0.03) and the spontaneous pain area (rs  = 0.25, P = 0.07), and the number of active MTPs was significantly correlated with the spontaneous pain area (rs  = 0.3, P = 0.03). In the MNP group, significant correlation was found only between pain duration and spontaneous pain area (rs  = 0.29, P = 0.02).

CONCLUSIONS:
Active MTPs are more prominent in WAD than MNP and related to current pain intensity and size of the spontaneous pain distribution in whiplash patients. This may underlie a lower degree of sensitization in MNP than in WAD.

Wiley Periodicals, Inc.

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Bariatric Surgery Lowers Risk for Uterine Cancer

Fran Lowry
March 24, 2014

Obese women could reduce their risk of developing uterine cancer by as much as 70% with bariatric surgery, according to new research.

And if the women maintain a normal weight after surgery, this dramatic decrease in risk is even better — up to 81%, said lead investigator Kristy Ward, MD, from the University of California, San Diego.

She presented the findings at the Society of Gynecologic Oncology 45th Annual Meeting on Women’s Cancer in Tampa, Florida.

“We know that endometrial cancer is strongly associated with obesity,” Dr. Ward told Medscape Medical News in a telephone interview.

In fact, “it has been estimated that as much as 37% of uterine cancer is associated with obesity,” she reported. Of all the obesity-related cancers, uterine cancer has the strongest association with obesity.

“Uterine cancer is also the most common cancer of the female reproductive organs, affecting about 50,000 women in 2013. Endometrial cancer, which occurs in the inner lining of the uterus, accounts for 95% of those cancers,” Dr. Ward said.

She and her group decided to see if bariatric surgery, with its resulting weight loss, decreases the risk for either uterine or endometrial cancer.

They used one of the largest healthcare databases in the United States — the University HealthSystem Consortium dataset — to analyze 7,431,858 women 18 years and older who were admitted to the hospital from January 2009 and June 2013.

Of the 103,797 women who had undergone bariatric surgery, 424 (0.4%) had a diagnosis of uterine malignancy. Of the 832,372 women considered obese who had not undergone bariatric surgery, 11,729 (1.4%) had that diagnosis.

“In other words, obese women who had bariatric surgery were 3 and a half times less likely to get uterine cancer than women who had not had the surgery,” Dr. Ward said.

For nonobese women who had never undergone bariatric surgery, 32,192 of the nearly 6.5 million admitted to the hospital (0.5%) were diagnosed with uterine cancer.

A Significant Finding

Anything that lowers the incidence of severe obesity is going to significantly decrease the risk for endometrial cancer, said Thomas Herzog, MD, division director of genitourinary oncology at Columbia University in New York City.

“Bariatric surgery is yet another prevention strategy that one could consider for someone who is massively obese and who has failed to lose weight through diet and exercise,” he noted.

However, Dr. Herzog, who was not involved with the study, cautioned that bariatric surgery is not without its risks.

“Most of these procedures go well, but there are reports of some patients who have lifelong problems after bariatric surgery, so that caveat has to be mentioned,” he explained.

“In this study, the success of bariatric surgery is not clearly described. Some people have great success at losing weight; some have had success but then have malnutrition. When you look at large population databases such as this, you don’t get the level of detail that you would like. Nonetheless, I think it’s a significant finding,” he told Medscape Medical News.

Dr. Ward and Dr. Herzog have disclosed no relevant financial relationships.

Society of Gynecologic Oncology (SGO) 45th Annual Meeting on Women’s Cancer: Abstract 4. Presented March 22, 2014.

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Stress Tied to Tough Time Conceiving

by Salynn Boyles
Contributing Writer, MedPage Today
March 24, 2014

High levels of the stress biomarker salivary alpha-amylase were associated with a greater likelihood of delayed pregnancy in women trying to conceive, according to researchers.

Women with the highest levels of alpha amylase at study entry, and following their first observed study menses, were twice as likely to fail to conceive over 12 months as women with the lowest levels of the stress biomarker (relative risk=2.07, 95% CI 1.04-4.11), reported Courtney Lynch, PhD, MPH, of The Ohio State University in Columbus, and colleagues, in Human Reproduction online.

This is the first U.S. study to show an association between stress — as measured by activation of the sympathetic adrenomedullary (SAM) pathway — and early infertility, the authors stated.

“We know that about one-third of infertility has an unknown cause,” Lynch told MedPage Today. “This tells us that by taking steps to reduce stress before attempting to become pregnant, many of these women may be able to optimize their fertility and avoid medical treatment. Stress may just be one small piece of the bigger picture in infertility, but I think it is a particularly interesting piece because it is something that a woman has the potential to change on her own.”…

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Comparison of the oswestry disability index and magnetic resonance imaging findings in lumbar canal stenosis: an observational study

Asian Spine J. 2014 Feb;8(1):44-50. doi: 10.4184/asj.2014.8.1.44. Epub 2014 Feb 6.

Comparison of the oswestry disability index and magnetic resonance imaging findings in lumbar canal stenosis: an observational study.

Goni VG1, Hampannavar A1, Gopinathan NR1, Singh P2, Sudesh P1, Logithasan RK1, Sharma A1, Bk S1, Sament R1.

Abstract

STUDY DESIGN:

Cross-sectional study.

PURPOSE:

The aim of the study was to determine relationship between the degrees of radiologically demonstrated anatomical lumbar canal stenosis using magnetic resonance imaging (MRI) and its correlation with the patient’s disability level, using the Oswestry Disability Index (ODI).

OVERVIEW OF LITERATURE:

The relationship between the imaging studies and clinical symptoms has been uncertain in patients suffering from symptomatic lumbar canal stenosis. There is a limited number of studies which correlates the degree of stenosis with simple reproducible scoring methods.

METHODS:

Fifty patients were selected from 350 patients who fulfilled the inclusion criteria. The patients answered the national-language translated form of ODI. The ratio of disability was interpreted, and the patients were grouped accordingly. They were subjected to MRI; and the anteroposterior diameters of the lumbar intervertebral disc spaces and the thecal sac cross sectional area were measured. Comparison was performed between the subdivisions of the degree of lumbar canal stenosis, based on the following: anteroposterior diameter (three groups: normal, relative stenosis and absolute stenosis); subdivisions of the degree of central canal stenosis, based on the thecal sac cross-sectional area, measured on axial views (three groups: normal, moderately stenotic and severely stenotic); and the ODI outcome, which was also presented in 20 percentiles.

RESULTS:

No significant correlation was established between the radiologically depicted anatomical lumbar stenosis and the Oswestry Disability scores.

CONCLUSIONS:

Magnetic resonance imaging alone should not be considered in isolation when assessing and treating patients diagnosed with lumbar canal stenosis.

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Research Shows Poorly Understood “Leaky Gut Syndrome” Is Real, May Be the Cause of Several Diseases

For decades, “leaky gut syndrome” was passed off as quackery. But new research shows it is indeed real, and may be the cause of asthma, irritable bowel syndrome, arthritis, and more.

Daniela Drake, M.D., M.B.A., is a former McKinsey & Co. consultant who is now a board-certified internist in private practice in Los Angeles.

03.27.14

Jane* was barely 40-years-old when her asthma caused her to turn blue and stop breathing. She was saved with chest compressions and weeks of intensive care. A year later, it happened again, causing the emergency medical system to convulse into action once more. For the next two years she was in-and-out of the hospital monthly for wheezing and shortness-of-breath—until I took over her care.

Following standard medical guidelines, I put her on a ludicrous amount of pharmaceuticals—and I managed to keep her out of the hospital for a year. I could have counted this as a victory if it weren’t for the fact that one thing bugged me: Why did she have asthma in the first place? She didn’t smoke and had no allergies, yet she was always on the verge of respiratory collapse.

Then I put her on a diet to heal her “leaky gut”—and she stopped wheezing completely. To me it looked like she was cured. It seemed the guidelines that the other doctors and I had followed were not only wrong—they were costly and dangerous. After all, she still landed in the ICU twice. If—as the leaky gut theory goes—bacteria and toxins were slipping into her system through a permeable intestine and wreaking havoc throughout her body, then she didn’t need impressive arsenals of expensive medicines. She didn’t even need a doctor. She needed a proper diet….

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Eating More Fruits and Vegetables Lowers CAC Burden in Women: CARDIA

Michael O’Riordan
March 28, 2014

WASHINGTON, DC — Long-term follow-up from the Coronary Artery Risk Development in Young Adults (CARDIA) study suggests that a higher consumption of fruits and vegetables in women is associated with a lower risk of developing coronary atherosclerosis.

Interestingly, the association between a diet rich in fruits and vegetables and coronary artery atherosclerosis was not observed in men, a finding that has been reported in previous trials.

“We know that lifestyle behaviors are really the foundation of cardiovascular-disease prevention, including diet,” said lead investigator Dr Michael Miedema (Minneapolis Heart Institute, MN) during a media briefing announcing the results. “There are several studies showing that a diet high in fruits and vegetables in middle-aged adults is associated with less coronary heart disease. As your fruit and vegetable intake goes up, your relative risk for developing coronary heart disease goes down. It’s been seen in several other studies, but it’s been most consistent in women….

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