2022-01 Phorest & Trees s/p Christmas COVID surprise

 

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.