PHOREST
NOT QUITE SCIENTIFIC/MEDICAL
- This past year of emails has reflected a manic intake of medical
articles related to the changes that came from the pandemic. Switching
from “read what’s right in front of me” to more directed topical reading. So
Probably not going to be sending these out for a while. Hope you’ve
enjoyed them 😊
- Yup i got sick with Omicron but it was nowhere near as bad as Unicron.
- Was going to share this
with Noble Jones but thought any of you interested in Engineering may want
to explore.
- Work with Dr. Norbury. Here's the link. https://jobs.physiatry.org/job/physiatry/58743934/
- Why
not Medicaid?
“25% of Medicaid claims had payment denied for at least one service.
Compare that to a denial rate of 7.3% for Medicare and 4.8% for commercial
insurers.”
- I
know the “No
Surprises Act” is a good thing overall but I feel like I don’t know
that it won’t make things worse for doctors. “Most doctors, however,
don't want to balance bill unsuspecting patients, and the No Surprises Act
leaves these doctors entirely out of its crosshairs. The elimination of an
unfair business practice -- surprise billing -- is why the No Surprises
Act is expected to reduce prices for some services. Any out-of-network
payment mandate set through arbitration is purely inflationary.”
- Already routinely asking this question of my patients. Nice to
know it’s validated
in some places.
- Tongue
in cheek study showing that rocket
scientists and brain surgeons aren’t necessarily as impressive as we
typically think.
PAIN/MSK
- The boys at JAMA really don’t like PRP.
- “This
systematic review and meta-analysis aimed to determine the
effectiveness of kinesiotaping (KT) with or without co-interventions in
patients with SIS (bursitis, tendinopathy of rotator cuff and partial tear
of supraspinatus), and the results showed that KT does not support an
effect in clinical outcomes in these patients. Additionally, we found
significant publication bias in KT with or without co-interventions. In
this context, our findings suggest no clinical or statistical differences
between KT groups versus control interventions in shoulder pain intensity
at 1–3 weeks (at rest, during activity, and at night) and 3–6 weeks (at
rest and during activity), shoulder function and shoulder ROM flexion at
1–3 weeks of treatment.”
- Previously thought to be painless, this retrospective
study found AMAN (GBS variant) seems to come with pain (especially
axial spine).
- JAMA, more
opiates prescribed when therapy not available…well duh!
- The hope is we can find yet another
way to avoid nerve biopsy.
- Corticosteroid
better than PRP in SI joint
- DOXIMITY
- Dexa
“gel” for lumbar epidural use? The whole thing seems a little sketchy
- Stem
cells improve CSF neurotrophic levels but may not improve function.
- Efficacy of cannabis-based
medications compared to placebo for the treatment of chronic neuropathic
pain: a systematic review with meta-analysis
- “As physicians, giving
nutritional advice while ignoring the sentimental, emotional aspect
of food might not best serve our patients if they can make better choices
about food while keeping certain traditions close.”
- Maybe there is a good reason my residents
love prescribing diclofenac
patches
- Always amazing to me that physical
therapy can be considered a control.
- Geeky study
that shows the non-exercised upper limb is more excitable after HIIT.
- “The weak
shoulder sign was highly sensitive in ALS, and was specific when
compared with MMN. The arm sparing sign was highly specific for ALS. These
two new signs are promising as clinical clues in the diagnosis of ALS.”
- Haven’t gotten to read the oral/topical treatment
guidelines for Painful Diabetic neuropathy yet.
- Really hard to interpret the findings of this review on inflammation
and pain in OA
- VA
has approved use of Walkasins Device
to improve gait for sensory neuropathy. Watch the two gait videos in the
middle of the page.
- Saw
a Charcot
Knee and unfortunately “there is no universal treatment algorithm,
perhaps due to lack of randomised control trails. The paucity of CK
literature, and the difficulty in measuring treatment effectiveness makes
it unlikely that any advocated treatment regimen will be standardised by
the orthopaedic community in the near future”
EDX/NM
- Had to evaluate yet another friend with Benign Fasciculation
Syndrome recently. And yet another study
shows that it does not progress to clinical weakness.
- Does
COVID
attack muscle/nerve directly? “muscle and nerve tissue demonstrated
inflammatory/immune-mediated damage likely related to release of cytokines.
There was no evidence of direct SARS-CoV-2 invasion of these tissues.”
- A quick summary. “All biomarkers for neuronal
injury were higher in the COVID CIN/CIM group than non-CIN/CIM, and
all correlated well with the degree of neuropathy seen on NCS.”
- A
quick summary. Some argue there’s no point in diagnosing a small-fiber
neuropathy. Well…what if you could treat
it?
- Remote exposure to lead, electrical burns, head injury found to be
risk
factors in USA for ALS consistent with prior studies.
- Small, large, and mixed fiber diabetic polyneuropathies had
similar frequencies of neuropathic
pain. Pure small and pure large
are uncommon. Microcirculation small fiber damage were more frequent with
skin biopsy abnormalities.” although diabetic polyneuropathy has
traditionally been considered a length-dependent distal axonopathy, a
considerable percentage of patients present a ganglionopathy-like pattern
of small-fiber loss. Interestingly, patients with distal axonopathy at
skin biopsy showed more severe distal axonal loss and higher pain
frequency than patients with a ganglionopathy-like pattern. Given the
small sample size, these data need further confirmation.” The fact that
pain with pure large-fiber polyneuropathy, was similar biopsy documented
small-fiber damage, raises the possibility that in patients with pure
large-fiber polyneuropathy who have neuropathic pain, nociceptive nerve
terminal involvement might be unnoticed by standard diagnostic techniques.
Ongoing burning pain may be associated with pathological overactivity of
regenerating sprouts. Prior studies have shown SFN affects the distal axon
but not
necessarily distal before proximal limb and hyperexcitability
of small fibers in pain syndromes.
- Diabetes,
but not pre-diabetes alone, is associated with SFN. Other metabolic
syndrome elements appear to preferentially impact small fiber structure
over function.
- I had never heard of CISP before (chronic
immune sensory polyradiculopathy) and I’m wondering how many I’ve missed.
- “When it is done correctly, bedside testing
requires overcoming the resistance of a muscle over a short distance,
which provides the examiner with a hint of muscle force over a short
distance and brief epoch of time, as well as an estimate of the effect of
a joint angle. As such, the seemingly simple relationship of muscle size
to muscle function is complicated by what exactly is meant by strength - is it
force, work or power?”
- “Contrary to what occurred in cervical lower
motor neurons (LMN), lower limb LMNs did not show a reduced F-wave
response to immobility, but their latency
increased significantly. This could have been due to reduced Renshaw
inhibition of small LMNs, thus facilitating their response to antidromic
stimulation and causing delayed late responses.”
- Statin/Exercise
effect on muscle. (1) exercise training improved oxidative capacity
as well as antioxidant capacity in the plantaris muscle; (2) oxidative
capacity was reduced after statin exposure in a dose-dependent manner; (3)
impairment of mitochondrial function was reduced in trained muscle after
atorvastatin exposure in the plantaris muscle; and (4) this protection
should be linked to improvement of mitochondrial respiration as well as
antioxidant capacity to decrease oxidative stress induced by atorvastatin
exposure.
TREES
- social media use was
associated with greater
likelihood of subsequent increase in depressive symptoms after
adjustment of other parameters.
- JAMA PRP
in Knee OA similar to saline
- "It’s not clear
where the (omicron)
variant actually emerged. It could be that South Africa and Botswana
saw it early because they have strong genetic sequencing
networks... if it did start in an African country, which remains
unknown — could underscore the message from health advocates that the
massive inequities in vaccine access are a global problem. The higher the
levels of transmission that are allowed to persist, the greater the chance
of new worrisome variants. Only about one in four people in South Africa
is fully immunized."
- High Mean
Resting Heartrate associated with development of Dementia.
- Evolutionary
explanations for exercise
and benefits to aging.
- A recent summary of the
evidence on phantom limb pain treatment and expert consensus https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8597012/
- I
have been fascinated by DROPPED HEAD presentations since seeing my first
as a new attending. This article
is the first to look at the histopathology and it’s intriguing that there
is ligament destruction in a majority.
- Abstract only: “A TUG
test time change of 2.1 s (or TUG z-score change of 1.5) indicates an
objective and clinically meaningful change in functional status.”
- Abstract
only. Epineural vessel anatomy defined in leprous ulnar neuropathies to
minimize vascular damage during release.
- You
may be surprised how much of a wild west it is out there with regard to who can legally perform
EDx.
- Abstract
only but would be so cool to read the full article on targeted
motor and sensory reinnervation and bionic prostheses
- Anyone
interested in sports medicine really should look at this
article. “meta-analysed the common measure of central hydration
status—delta plasma volume—and found that hypotonic
carbohydrate–electrolyte drinks ingested continuously during exercise
provide the greatest benefit to hydration when compared with hypertonic
drinks, isotonic drinks and water.” But to me it was even more
interesting to see how each particular ingredient affected gastric
emptying and jejunal absorption (nicely summarized in the tables).
- “WE TALK ABOUT HOW TO
AVOID TRACKING, BECAUSE IT’S NOT HEALTHY FOR THEM. WE WANT THEM TO BE
MORE MINDFUL.”
- The Discussion section on this perfusion/cadaver
ultrasound study of cubital tunnel is excellent reading for anyone
dealing with entrapments.
- Is obesity
more than just a thermodynamic problem?
- I am a pansplainer
indeed
- The LOPOID
protocol works.