Circulatory failure, especially with low systemic vascular resistance (SVR), as observed in septic shock, thyrotoxicosis, and anemia, is a particular pattern that should suggest thiamine (vitamin B1) deficiency. The clinical picture of wet beriberi secondary to thiamine deficiency only demonstrates non-specific clinical manifestations. This article presents a rare case of wet beriberi associated with multiple organ failure (MOF) in a prison patient with years of heavy alcohol consumption (1). The patient started treatment with thiamine (100 mg) by intramuscular injection, together with basic supportive care. The outcomes were that the hemodynamic indices improved within 12 hours after thiamine administration. Echocardiographic examinations revealed right ventricular function improvement within a few days, which were normal within a month. The authors conclude a diagnosis of wet beriberi should be considered for a prison patient who has unexplained heart failure, lactic acidosis, and/or MOF. Moreover, the patient should be empirically given thiamine administration without delay.

References

(1) Lei Y, et al. Wet beriberi with multiple organ failure remarkably reversed by thiamine administration: A case report and literature review. Medicine (Baltimore). 2018;97(9):e0010.

Vitamin D has been proposed to have anti-inflammatory properties. This study was a meta-analysis to examine the effects on inflammatory markers (1). Multiple databases were searched and randomized controlled trials were identified for analysis. The results showed that 28 studies were included. Vitamin D lowered C-reactive protein, TNF-alpha, and ESR – all inflammatory markers. This meta-analysis provides level 1 evidence that vitamin D supplementation may reduce chronic low-grade inflammation in patients with type 2 diabetes.

References

(1) Mousa A, et al. Vitamin D supplementation for improvement of chronic low-grade inflammation in patients with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Nutr Rev. 2018;doi:10.1093/nutrix/nux077.

Recommended fish intake differs substantially from observed fish intake. In Denmark, ∼15% of the population consumes the state-recommended fish intake. How much fish individuals eat varies greatly, and this variation cannot be captured by considering the fish intake of the average population. The objective of this study was to propose specific fish intake levels for individuals that meet the recommendations for eicosapentaenoic acid, docosahexaenoic acid, and vitamin D without violating the permitted intake recommendations for methyl mercury, dioxins, and polychlorinated biphenyls (1). Results showed that individual, personal dietary recommendations were successfully modeled. Modeled fish intake levels were compared to observed fish intakes. For women, the average proposed increase in fish intake was 14 g/wk for lean fish and 63 g/wk for fatty fish; and for men these numbers were 12 and 55 g/wk, respectively. The authors conclude this approach has the potential to increase compliance with dietary guidelines by targeting the individual consumers and minimizing the need for large and ultimately unrealistic behavior changes.

References

(1) Persson M, et al. Use of Mathematical Optimization Models to Derive Healthy and Safe Fish Intake. J Nutr. 2018;148(2):275-284.

In this study, the authors evaluated the effectiveness and safety of outpatient balneological treatment consisting of hydrotherapy and peloid therapy in elderly patients with osteoarthritis (1). Hydrotherapy was applied as head-out immersion in a tap water pool at 36-38 °C for 20 min and then peloid therapy was applied as a local peloid pack on the painful region or joint at 42-43 °C for 20 min, on each weekday for 2 weeks. Patients were evaluated before and after the treatment and outcome measurements were pain, patient's global assessment, physician's global assessment, Western Ontario and McMaster Universities index, Lequesne hip index, Waddell index, neck pain and disability scale, and health assessment questionnaire. In total, 235 osteoarthritis patients were included in the analysis. The authors found significant improvements in pain and function scores in generalized, knee, lumbar, cervical and hand osteoarthritis. The results showed that the majority of patients (59.1%) fulfilled the outcome measures in Rheumatology-Osteoarthritis Research Society International responder criteria. The treatment demonstrated a good safety profile. The authors conclude this may be a worthwhile therapy for these patients.

References

(1) Kardes S, et al. Outpatient balneological treatment of osteoarthritis in older persons : A retrospective study. Z Gerontol Geriatr. 2018;doi: 10.1007/s00391-018-1370-3.

Constant exposure to various stressors are leading to an increase in immunocompromising health conditions (1). In this review, the authors discuss the role of herbal immunomodulators. Synthetic chemotherapeutic agents, which are widely available in the commercial market, may be highly efficacious, but most are immunosuppressive and exert many side effects. Numerous herbs used in ethnoveterinary medicine can be successfully employed as adjuvant rehabilitators to negate the deleterious effects of chemotherapeutics. Globally, many studies have been conducted on these herbs and have revealed unique active constituents that activate the innate immune system through the stimulation of macrophages and lymphocytes, and modulation of the cytokine profile, which leads to a state of alertness with a subsequent reduction in the incidence of infection.

References

(1) Tiwari R, et al. Herbal immunomodulators, a remedial panacea for the designing and developing effective drugs and medicines: Current scenario and future prospects. Curr Drug Metab. 2018; doi: 10.2174/1389200219666180129125436.

In this study, the authors reported on the long-term (up to 1 year) outcomes of acupuncture as a primary and independent treatment in patients with insomnia. The patient was evaluated with polysomnography. In this study, the diagnosis of chronic insomnia was based on the International Classification of Sleep Disorders insomnia. The patient had no obvious differential diagnosis. Acupuncture treatment was planned for this patient who refused to take medical treatment with chronic insomnia. So the patient received 1 hour of acupuncture treatment for 12 weeks. Polysomnographic evaluation was performed at baseline and 3 months, and 1 year after acupuncture treatment. He was asked to keep a diary of all his insomnia-related symptoms. All outcome measures substantially improved. Moreover, during the observation period, the patient's sleep quality did not worsen. The authors conclude that acupuncture is a viable therapy for chronic insomnia.

References

(1) Zhang W, et al. Acupuncture as a primary and independent treatment in chronic insomnia. Medicine (Baltimore). 2017;96(52):e9471.

In this study, the authors evaluated which factors predicated a high patient throughput to add more evidence to the body of naturopathic evidence (1). It was a cross-sectional study sampling 1096 practitioners in Germany. Besides, sociodemographic data and practice characteristics topics like job satisfaction and feeling for the job were evaluated. This was supplemented with an evaluation of patient traits which were perceived as challenging. The results showed that the naturopathic practitioners were very satisfied with their job. Naturopathic practitioners described that 40% of their patients are challenging. The highest rate was for "aggressive patients." A high patient throughput was predicted with a higher satisfaction rate with the "opportunity to use abilities" and more direct contact with the patient. The authors conclude that therapeutic freedom and time with patients are important factors which are accountable for a high patient throughput.

References

(1) Goetz K, et al. The Phenomena of Naturopathic Practitioner: Predictors of a High Patient Throughput. Evid Based Complement Alternat Med. 2017;2017:9758326.

Based on a growing body of evidence implicating low vitamin D status in the development of cardiovascular disease, the authors hypothesized that in Canadian HIV-positive adults, low vitamin D concentration would be associated with increased subclinical vascular disease progression (1). In this study, they analyzed the association. The results showed mean progression was 0.027 mm/year. Only 13.3% of participants were vitamin D deficient (25(OH)D < 50 nmol/L), whereas 61.7% had a 25(OH)D exceeding the sufficiency threshold (75 nmol/L). The authors conclude that baseline vitamin D was associated with carotid intima-media thickness progression in this relatively vitamin D replete, predominately white and male, Canadian HIV-positive population.

References

(1) Huff H, et al. Vitamin D and progression of carotid intima-media thickness in HIV-positive Canadians. HIV Med. 2018;19(2):143-151.