For years I have run a casual email
list serving the chiropractic profession, its students
and various interested non-chiropractor supporters.
Jun 2007
Issue 3
07/06/07 21:37
Some
very interesting stuff here, as usual. Useful for
self and patients alike.
-=-=-=-=-=-=-=-=-=-=
...some help if you have muscular pain while taking cholesterol drugs. CoQ10 is now readily available and may help, according to this one.
joe
Am J Cardiol. 2007 May 15;99(10):1409-12. Epub 2007 Apr 3.
Effect of coenzyme q10 on myopathic symptoms in patients treated with statins.
Caso G,Kelly P,McNurlan MA,Lawson WE.
Department of Surgery, Division of Cardiology, Stony Brook University, Stony Brook, NY, USA. giuseppe.caso@stonybrook.edu
Treatment of hypercholesterolemia with statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) is effective in the primary and secondary prevention of cardiovascular disease.
However, statin use is often associated with a variety of muscle-related symptoms or myopathies.
Myopathy may be related in part to statin inhibition of the endogenous synthesis of coenzyme Q10, an essential cofactor for mitochondrial energy production.
The aim of this study is to determine whether coenzyme Q10 supplementation would reduce the degree of muscle pain associated with statin treatment.
Patients with myopathic symptoms were randomly assigned in a double-blinded protocol to treatment with coenzyme Q10 (100 mg/day, n = 18) or vitamin E (400 IU/day, n = 14) for 30 days. Muscle pain and pain interference with daily activities were assessed before and after treatment. After a 30-day intervention, pain severity decreased by 40% (p <0.001) and pain interference with daily activities decreased by 38% (p <0.02) in the group treated with coenzyme Q10. In contrast, no changes in pain severity (+9%, p = NS) or pain interference with daily activities (-11%, p = NS) was observed in the group treated with vitamin E.
In conclusion, results suggest that coenzyme Q10 supplementation may decrease muscle pain associated with statin treatment. Thus, coenzyme Q10 supplementation may offer an alternative to stopping treatment with these vital drugs.
-=-=-=-=-=-=-=-=-
Chiropractors are interested in what drives CSF...here is somewhere to start. Bolton, one author, is a chiropractor and has been doing quality grass-roots neuro-science research for years.
http://www.jmptonline.org/article/PIIS0161475407001236/abstract
Cerebrospinal Fluid Pressure in the Anesthetized Rat
Brian S. Budgell, PhDa,Philip S. Bolton, PhDbc
Received 12 September 2006; received in revised form 20 February 2007; accepted 27 March 2007
Abstract
Objective
The primary aims of this study were to determine the major frequencies and powers of oscillations in cerebrospinal fluid (CSF) pressure in the anesthetized rat, and determine whether the CSF pressure oscillations correlated with the major oscillation frequencies in the cardiovascular and respiratory systems as proposed by some chiropractic theories.
Methods
The cardiac and ventilatory cycles, and CSF pressure were simultaneously recorded during spontaneous and positive-pressure mechanical ventilation in the anesthetized rat. Power spectra were generated from the raw data to identify the major oscillation frequencies in cardiorespiratory and CSF data sets. Entrainment of CSF pressure with ventilation was tested by mechanically pacing the ventilation over a range of frequencies.
Results
The most powerful oscillation in CSF pressure was coincident with ventilatory chest movement during both spontaneous and mechanically paced ventilation. In 22 of 26 trials, there was also a very weak oscillation in CSF pressure that was entrained to heart rate. In addition, in 21 of 26 trials, it was possible to identify a low-frequency oscillation (<0.25 Hz) in CSF pressure that was coincident with a low-frequency oscillation in the power spectrum of the cardiac cycle.
Conclusions
This study suggests oscillations in CSF pressure in the anesthetized rat are entrained to and driven by ventilation. The arterial pulse pressure makes little contribution to oscillations in CSF pressure in the immobile, anesthetized rat. This study provides normative, quantitative data on which to develop studies concerning the effects of vertebral movements and spinal posture on CSF dynamics.
-=-=-=-=-
ommon
colds resolve without antibiotics, but you knew that
right?
Acute Purulent Rhinitis Often Resolves Without Antibiotics
July 25, 2006 --
Antibiotics may be helpful for acute purulent rhinitis but may also be harmful, according to the results of a meta-analysis reported in the July 21 Online First issue of theBMJ. Most will get better without antibiotics, supporting the "no antibiotics first" guideline.
"Most guidelines recommend that antibiotics should not be used for this condition, citing one study that found no evidence that antibiotics reduce the duration of acute purulent rhinitis," write B. Arroll, MD, and T. Kenealy, MD, from the University of Auckland in New Zealand, and colleagues. "However, a recent larger study reported that treatment with amoxicillin reduced the duration of purulent rhinitis, although it found no significant difference between the groups in terms of general improvement in symptoms. Concern exists about overuse of antibiotics leading to bacterial resistance."
Using MEDLINE, Embase, Cochrane Register of Controlled Trials, and reference lists of retrieved articles, the authors systematically searched for studies on the effectiveness and harms of antibiotics for acute purulent rhinitis. They then did a review and meta-analysis of data from double-blind, randomized, placebo-controlled trials comparing antibiotics with placebo for acute purulent rhinitis of duration less than 10 days.
Of 7 studies retrieved, 4 contributed data on the benefits of antibiotics, and 4 contributed data on harms of antibiotics. At 5 to 8 days, the pooled relative risk of benefit for persistent purulent rhinitis with antibiotics was 1.18 (95% confidence interval [CI], 1.05 - 1.33). When the pooled relative risk was applied to the range of control event rates, the numbers needed to treat ranged from 7 to 15.
The relative risk for adverse effects with antibiotics was 1.46 (95% CI, 1.10 - 1.94), and the numbers needed to harm for various adverse effects ranged from 12 to 78. Harms attributed to antibiotics were primarily vomiting, diarrhea, and abdominal pain, but there were also some reports of rashes and hyperactivity. There were no serious harms reported in the placebo groups.
"Antibiotics are probably effective for acute purulent rhinitis," the authors write. "They can cause harm, usually in the form of gastrointestinal effects. Most patients will get better without antibiotics, supporting the current 'no antibiotic as first line' advice."
Study limitations include the possibility of missing some relevant articles because various terms are used for acute purulent rhinitis, publication bias, and use of different antibiotics in the various studies.
"Our summation would be to suggest initial management by non-antibiotic treatments or 'watchful waiting,' and that antibiotics should be used only when symptoms have persisted for long enough to concern parents or patients," the authors conclude. "In this case, antibiotic treatment may be considered, given that the harms were usually gastrointestinal adverse effects and that individual patients may be aware of their own ability to tolerate specific antibiotics. Our findings are consistent with the review on antibiotics for chronic purulent rhinitis, and we do not feel that more randomised controlled trials on this subject are warranted."
This review was funded by the Charitable Trust of the Auckland Faculty of the Royal New Zealand College of General Practitioners, and the authors' salaries were from University of Auckland staff funding. Dr. Arroll has disclosed being a member of the Future Forum, an educational foundation funded by AstraZeneca UK, and a committee member of the Pharmac seminar series (Pharmac is the New Zealand government funding agency for drugs).
BMJ. Published online July 21, 2006
--=-=-=-=-=-=-=-=-=-=-=
Doggies and Us
Effect of dog-walking on autonomic nervous activity in senior citizens
Masahiko Motooka, Hiroto Koike, Tomoyuki Yokoyama and Nell L Kennedy
http://www.mja.com.au/public/issues/184_02_160106/mot10618_fm.html
Abstract
Objective: To compare changes in autonomic nervous activity in healthy senior individuals while walking with and without a dog, and during routine activities at home and periods of interacting with the dog at home.
Design: Controlled crossover study.
Participants and setting: 13 healthy volunteers (3 men, 10 women; mean age, 67.5 years) who walked in a park adjacent to Gunma University, Japan, and 4 volunteers among these who underwent monitoring in their own homes.
Interventions: Heart rate variability was monitored continuously by means of a palm-sized electrocardiographic monitor (which facilitated spectral analysis of the RR interval) while participants walked for 30 minutes (first with, then without, the study dog, or vice versa); three participants underwent this intervention on 3 consecutive days. Four participants underwent continuous monitoring for 6 hours in their own homes, including two 30-minute periods of free interaction with the study dog.
Main outcome measures: High frequency (HF) power values of heart rate variability, which is a measure of parasympathetic neural activity.
Results: During dog-walking, HF power increased significantly (P < 0.01); this increase was sustained throughout each dog walk, and was more pronounced during succeeding dog walks. At home, HF power was 1.87 times greater when the dog was present, and 1.57 times greater (P < 0.01) than in the walking experiment.
Conclusions: Walking a dog has potentially greater health benefits as a buffer against stress in senior citizens than walking without a dog; and, independent of actually walking, merely patting and talking to a dog also raises parasympathetic neural activity. Power spectral analysis of heart rate variability shows promise as a non-invasive approach to quantifying clinicophysiological research on human health benefits possibly derived from interaction with companion animals.
thanks dr Sanjay Patel for this one :-)
-=-=-=-=-=-=-=-=-
How about all that Tylenol or Panadol they give to kids?
Is it safe?
Take the Nurses advice below:
Acetaminophen Toxicity
Taking too much acetaminophen can cause big problems. This drug should not be used casually.
Journal for Nurse Practitioners 3(3) 2007
-=-=-=-==-=--=-
Another one that might prick up your ears, thanks to Dr Rome, one of my regular contributors. How reliable is the reliable old "systematic review"?
www.medscape.com
Epidemiology and Reporting Characteristics of Systematic Reviews
How good is the evidence from systematic reviews?
PLoS Med 4(3) 2007
Epidemiology and Reporting Characteristics of Systematic Reviews
David Moher; Jennifer Tetzlaff; Andrea C. Tricco; Margaret Sampson; Douglas G. Altman
PLoS Med. 2007;4(3) ©2007 Public Library of Science
Posted 05/23/2007
Abstract and Introduction
Abstract
Background: Systematic reviews (SRs) have become increasingly popular to a wide range of stakeholders. We set out to capture a representative cross-sectional sample of published SRs and examine them in terms of a broad range of epidemiological, descriptive, and reporting characteristics, including emerging aspects not previously examined.
Methods and Findings: We searched Medline for SRs indexed during November 2004 and written in English. Citations were screened and those meeting our inclusion criteria were retained. Data were collected using a 51-item data collection form designed to assess the epidemiological and reporting details and the bias-related aspects of the reviews. The data were analyzed...
Conclusions: SRs are now produced in large numbers, and our data suggest that the quality of their reporting is inconsistent. This situation might be improved if more widely agreed upon evidence-based reporting guidelines were endorsed and adhered to by authors and journals. These results substantiate the view that readers should not accept SRs uncritically.
-=-=-=-=-=-=-=-=-=-=
...some help if you have muscular pain while taking cholesterol drugs. CoQ10 is now readily available and may help, according to this one.
joe
Am J Cardiol. 2007 May 15;99(10):1409-12. Epub 2007 Apr 3.
Effect of coenzyme q10 on myopathic symptoms in patients treated with statins.
Caso G,Kelly P,McNurlan MA,Lawson WE.
Department of Surgery, Division of Cardiology, Stony Brook University, Stony Brook, NY, USA. giuseppe.caso@stonybrook.edu
Treatment of hypercholesterolemia with statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) is effective in the primary and secondary prevention of cardiovascular disease.
However, statin use is often associated with a variety of muscle-related symptoms or myopathies.
Myopathy may be related in part to statin inhibition of the endogenous synthesis of coenzyme Q10, an essential cofactor for mitochondrial energy production.
The aim of this study is to determine whether coenzyme Q10 supplementation would reduce the degree of muscle pain associated with statin treatment.
Patients with myopathic symptoms were randomly assigned in a double-blinded protocol to treatment with coenzyme Q10 (100 mg/day, n = 18) or vitamin E (400 IU/day, n = 14) for 30 days. Muscle pain and pain interference with daily activities were assessed before and after treatment. After a 30-day intervention, pain severity decreased by 40% (p <0.001) and pain interference with daily activities decreased by 38% (p <0.02) in the group treated with coenzyme Q10. In contrast, no changes in pain severity (+9%, p = NS) or pain interference with daily activities (-11%, p = NS) was observed in the group treated with vitamin E.
In conclusion, results suggest that coenzyme Q10 supplementation may decrease muscle pain associated with statin treatment. Thus, coenzyme Q10 supplementation may offer an alternative to stopping treatment with these vital drugs.
-=-=-=-=-=-=-=-=-
Chiropractors are interested in what drives CSF...here is somewhere to start. Bolton, one author, is a chiropractor and has been doing quality grass-roots neuro-science research for years.
http://www.jmptonline.org/article/PIIS0161475407001236/abstract
Cerebrospinal Fluid Pressure in the Anesthetized Rat
Brian S. Budgell, PhDa,Philip S. Bolton, PhDbc
Received 12 September 2006; received in revised form 20 February 2007; accepted 27 March 2007
Abstract
Objective
The primary aims of this study were to determine the major frequencies and powers of oscillations in cerebrospinal fluid (CSF) pressure in the anesthetized rat, and determine whether the CSF pressure oscillations correlated with the major oscillation frequencies in the cardiovascular and respiratory systems as proposed by some chiropractic theories.
Methods
The cardiac and ventilatory cycles, and CSF pressure were simultaneously recorded during spontaneous and positive-pressure mechanical ventilation in the anesthetized rat. Power spectra were generated from the raw data to identify the major oscillation frequencies in cardiorespiratory and CSF data sets. Entrainment of CSF pressure with ventilation was tested by mechanically pacing the ventilation over a range of frequencies.
Results
The most powerful oscillation in CSF pressure was coincident with ventilatory chest movement during both spontaneous and mechanically paced ventilation. In 22 of 26 trials, there was also a very weak oscillation in CSF pressure that was entrained to heart rate. In addition, in 21 of 26 trials, it was possible to identify a low-frequency oscillation (<0.25 Hz) in CSF pressure that was coincident with a low-frequency oscillation in the power spectrum of the cardiac cycle.
Conclusions
This study suggests oscillations in CSF pressure in the anesthetized rat are entrained to and driven by ventilation. The arterial pulse pressure makes little contribution to oscillations in CSF pressure in the immobile, anesthetized rat. This study provides normative, quantitative data on which to develop studies concerning the effects of vertebral movements and spinal posture on CSF dynamics.
-=-=-=-=-
|
Welcome to issue 3
|
| C |
|
good for patient info?
joe |
Acute Purulent Rhinitis Often Resolves Without Antibiotics
July 25, 2006 --
Antibiotics may be helpful for acute purulent rhinitis but may also be harmful, according to the results of a meta-analysis reported in the July 21 Online First issue of theBMJ. Most will get better without antibiotics, supporting the "no antibiotics first" guideline.
"Most guidelines recommend that antibiotics should not be used for this condition, citing one study that found no evidence that antibiotics reduce the duration of acute purulent rhinitis," write B. Arroll, MD, and T. Kenealy, MD, from the University of Auckland in New Zealand, and colleagues. "However, a recent larger study reported that treatment with amoxicillin reduced the duration of purulent rhinitis, although it found no significant difference between the groups in terms of general improvement in symptoms. Concern exists about overuse of antibiotics leading to bacterial resistance."
Using MEDLINE, Embase, Cochrane Register of Controlled Trials, and reference lists of retrieved articles, the authors systematically searched for studies on the effectiveness and harms of antibiotics for acute purulent rhinitis. They then did a review and meta-analysis of data from double-blind, randomized, placebo-controlled trials comparing antibiotics with placebo for acute purulent rhinitis of duration less than 10 days.
Of 7 studies retrieved, 4 contributed data on the benefits of antibiotics, and 4 contributed data on harms of antibiotics. At 5 to 8 days, the pooled relative risk of benefit for persistent purulent rhinitis with antibiotics was 1.18 (95% confidence interval [CI], 1.05 - 1.33). When the pooled relative risk was applied to the range of control event rates, the numbers needed to treat ranged from 7 to 15.
The relative risk for adverse effects with antibiotics was 1.46 (95% CI, 1.10 - 1.94), and the numbers needed to harm for various adverse effects ranged from 12 to 78. Harms attributed to antibiotics were primarily vomiting, diarrhea, and abdominal pain, but there were also some reports of rashes and hyperactivity. There were no serious harms reported in the placebo groups.
"Antibiotics are probably effective for acute purulent rhinitis," the authors write. "They can cause harm, usually in the form of gastrointestinal effects. Most patients will get better without antibiotics, supporting the current 'no antibiotic as first line' advice."
Study limitations include the possibility of missing some relevant articles because various terms are used for acute purulent rhinitis, publication bias, and use of different antibiotics in the various studies.
"Our summation would be to suggest initial management by non-antibiotic treatments or 'watchful waiting,' and that antibiotics should be used only when symptoms have persisted for long enough to concern parents or patients," the authors conclude. "In this case, antibiotic treatment may be considered, given that the harms were usually gastrointestinal adverse effects and that individual patients may be aware of their own ability to tolerate specific antibiotics. Our findings are consistent with the review on antibiotics for chronic purulent rhinitis, and we do not feel that more randomised controlled trials on this subject are warranted."
This review was funded by the Charitable Trust of the Auckland Faculty of the Royal New Zealand College of General Practitioners, and the authors' salaries were from University of Auckland staff funding. Dr. Arroll has disclosed being a member of the Future Forum, an educational foundation funded by AstraZeneca UK, and a committee member of the Pharmac seminar series (Pharmac is the New Zealand government funding agency for drugs).
BMJ. Published online July 21, 2006
--=-=-=-=-=-=-=-=-=-=-=
Doggies and Us
Effect of dog-walking on autonomic nervous activity in senior citizens
Masahiko Motooka, Hiroto Koike, Tomoyuki Yokoyama and Nell L Kennedy
http://www.mja.com.au/public/issues/184_02_160106/mot10618_fm.html
Objective: To compare changes in autonomic nervous activity in healthy senior individuals while walking with and without a dog, and during routine activities at home and periods of interacting with the dog at home.
Design: Controlled crossover study.
Participants and setting: 13 healthy volunteers (3 men, 10 women; mean age, 67.5 years) who walked in a park adjacent to Gunma University, Japan, and 4 volunteers among these who underwent monitoring in their own homes.
Interventions: Heart rate variability was monitored continuously by means of a palm-sized electrocardiographic monitor (which facilitated spectral analysis of the RR interval) while participants walked for 30 minutes (first with, then without, the study dog, or vice versa); three participants underwent this intervention on 3 consecutive days. Four participants underwent continuous monitoring for 6 hours in their own homes, including two 30-minute periods of free interaction with the study dog.
Main outcome measures: High frequency (HF) power values of heart rate variability, which is a measure of parasympathetic neural activity.
Results: During dog-walking, HF power increased significantly (P < 0.01); this increase was sustained throughout each dog walk, and was more pronounced during succeeding dog walks. At home, HF power was 1.87 times greater when the dog was present, and 1.57 times greater (P < 0.01) than in the walking experiment.
Conclusions: Walking a dog has potentially greater health benefits as a buffer against stress in senior citizens than walking without a dog; and, independent of actually walking, merely patting and talking to a dog also raises parasympathetic neural activity. Power spectral analysis of heart rate variability shows promise as a non-invasive approach to quantifying clinicophysiological research on human health benefits possibly derived from interaction with companion animals.
thanks dr Sanjay Patel for this one :-)
-=-=-=-=-=-=-=-=-
How about all that Tylenol or Panadol they give to kids?
Is it safe?
Take the Nurses advice below:
Acetaminophen Toxicity
Taking too much acetaminophen can cause big problems. This drug should not be used casually.
Journal for Nurse Practitioners 3(3) 2007
-=-=-=-==-=--=-
Another one that might prick up your ears, thanks to Dr Rome, one of my regular contributors. How reliable is the reliable old "systematic review"?
www.medscape.com
Epidemiology and Reporting Characteristics of Systematic Reviews
How good is the evidence from systematic reviews?
PLoS Med 4(3) 2007
Epidemiology and Reporting Characteristics of Systematic Reviews
David Moher; Jennifer Tetzlaff; Andrea C. Tricco; Margaret Sampson; Douglas G. Altman
PLoS Med. 2007;4(3) ©2007 Public Library of Science
Posted 05/23/2007
|
|
Abstract and Introduction
Abstract
Background: Systematic reviews (SRs) have become increasingly popular to a wide range of stakeholders. We set out to capture a representative cross-sectional sample of published SRs and examine them in terms of a broad range of epidemiological, descriptive, and reporting characteristics, including emerging aspects not previously examined.
Methods and Findings: We searched Medline for SRs indexed during November 2004 and written in English. Citations were screened and those meeting our inclusion criteria were retained. Data were collected using a 51-item data collection form designed to assess the epidemiological and reporting details and the bias-related aspects of the reviews. The data were analyzed...
Conclusions: SRs are now produced in large numbers, and our data suggest that the quality of their reporting is inconsistent. This situation might be improved if more widely agreed upon evidence-based reporting guidelines were endorsed and adhered to by authors and journals. These results substantiate the view that readers should not accept SRs uncritically.
|