Current Alternative-medicine News Results

Age estimation from the rib by components method analysis in white males.

Am J Forensic Med Pathol. 2010 Mar; 31(1): 27-33
Verzeletti A, Cassina M, Micheli L, Lorenzo A, De Ferrari F

Changes at the sternal extremity of the fourth rib have already been established as reliable indicators of age at death. Still now, the Iscan "phase method," based on the morphologic changes at the sternal extremity of the fourth rib, is one of the best effective for age estimation at death. The present study was carried out to develop an alternative method considering the morphologic characteristics of articular surface (A), anterior/posterior walls (B), and superior/inferior edges (C) of the sternal extremity of the fourth rib. For each parameter a numerical score was assigned and some regression formulae was elaborated. The best correlation between morphologic characteristics and age was obtained through the formula Age = 10.43 (AB)(0.53). The sample consisted of sternal extremities of the fourth rib obtained at autopsy from 49 white males of known age.

A weighted Cox model for modelling time-dependent exposures in the analysis of case-control studies.

Stat Med. 2010 Mar 8; 29(7-8): 839-850
Leffondre K, Wynant W, Cao Z, Abrahamowicz M, Heinze G, Siemiatycki J

Many exposures investigated in epidemiological case-control studies may vary over time. The effects of these exposures are usually estimated using logistic regression, which does not directly account for changes in covariate values over time within individuals. By contrast, the Cox model with time-dependent covariates directly accounts for these changes over time. However, the over-sampling of cases in case-control studies, relative to controls, requires manipulating the risk sets in the Cox partial likelihood. A previous study showed that simple inclusion or exclusion of future cases in each risk set induces an under- or over-estimation bias in the regression parameters, respectively. We investigate the performance of a weighted Cox model that weights subjects according to age-conditional probabilities of developing the disease of interest in the source population. In a simulation study, the lifetime experience of a source population is first generated and a case-control study is then simulated within each population. Different characteristics of exposure are generated, including time-varying intensity. The results show that the estimates from the weighted Cox model are much less biased than the Cox models that simply include or exclude future cases, and are superior to logistic regression estimates in terms of bias and mean-squared error. An application to frequency-matched population-based case-control data on lung cancer illustrates similar differences in the estimated effects of different smoking variables. The investigated weighted Cox model is a potential alternative method to analyse matched or unmatched population-based case-control studies with time-dependent exposures. Copyright (c) 2010 John Wiley & Sons, Ltd.

Can the caudal extent of fusion in the surgical treatment of scoliosis in Duchenne muscular dystrophy be stopped at lumbar 5?

Eur Spine J. 2010 Mar 7;
Takaso M, Nakazawa T, Imura T, Ueno M, Saito W, Shintani R, Takahashi K, Yamazaki M, Ohtori S, Okamoto M, Masaki T, Okamoto H, Okutomi T, Ishii K, Ueda Y

Instrumentation and fusion to the sacrum/pelvis has been a mainstay in the surgical treatment of scoliosis in Duchenne muscular dystrophy (DMD) and is recommended to correct pelvic obliquity. The caudal extent of instrumentation and fusion in the surgical treatment of scoliosis in DMD has remained a matter of considerable debate, and there have been few studies on the use of segmental pedicle screw instrumentation for this pathology. From 2004 to 2007, a total of 28 patients with DMD underwent segmental pedicle screw instrumentation and fusion only to L5. Assessment was performed clinically and with radiologic measurements. All patients had a curve with the apex at L2 or higher preoperatively. Preoperative coronal curve averaged 74 degrees , with a postoperative mean of 14 degrees , and 17 degrees at the last follow-up. The pelvic obliquity improved from 17 degrees preoperatively to 6 degrees postoperatively, and 6 degrees at the last follow-up. Good sagittal plane alignment was recreated after surgery and maintained long term. In 23 patients with a preoperative L5 tilt of less than 15 degrees , the pelvic obliquity was effectively corrected to less than 10 degrees and maintained by adequately addressing spinal deformity, while five patients with a preoperative L5 tilt of more than 15 degrees had a postoperative pelvic obliquity of more than 15 degrees . Segmental pedicle screw instrumentation and fusion to L5 was effective and safe in patients with DMD scoliosis with a minimal L5 tilt (<15 degrees ) and a curve with the apex at L2 or higher, both initially and long term, obviating the need for fixation to the sacrum/pelvis. Segmental pedicle screw instrumentation and fusion to L5 was safe and effective in patients with DMD scoliosis with stable L5/S1 articulation as evidenced by a minimal L5 tilt of less than 15 degrees , even though pelvic obliquity was significant. There was no major complication. With rigid segmental pedicle screw instrumentation, the caudal extent of fusion in the treatment of DMD scoliosis should be determined by the degree of L5 tilt. This method in appropriate patients can be a viable alternative to instrumentation and fusion to the sacrum/pelvis in the surgical treatment of DMD scoliosis.

Can treatment delay be utilized as a key variable for monitoring the pool of infectious tuberculosis in a population?

J Infect Dev Ctries. 2010; 4(2): 83-90
Storla DG, Yimer S, Bjune GA

BACKGROUND: A major goal of tuberculosis control programs is to stop community transmission of Mycobacterium tuberculosis. However, this can not be rapidly accomplished because, in endemic areas, most of the population is already infected, serving as a reservoir that continuously contributes to the pool of infectious cases. Tuberculin surveys are the main tools used to monitor the infectious pool, but there are serious methodological constraints, and they require resources and expertise that are often unavailable. There is an urgent need for alternative means to monitor the epidemic at the local level. METHODOLOGY: We investigated whether a systematic registration of treatment delay in the tuberculosis program records of the Amhara Region of Ethiopia could be utilized to estimate the infectious pool of tuberculosis. RESULTS: The study showed that the total number of infectious days and hence an estimate of the infectious pool could be calculated by recording the treatment delay for new TB cases, retreatment cases and failures, and by estimating the number of undiagnosed cases. Of these categories, treatment delay among new smear-positive tuberculosis cases contributes the greatest number of infectious days. CONCLUSIONS: A local tuberculosis program can use a systematic recording of treatment delay as a quantifiable variable to monitor the infectious pool, and can also serve as a key indicator of program performance.

Increased susceptibility of Nrf2 null mice to 1-bromopropane-induced hepatotoxicity.

Toxicol Sci. 2010 Mar 8;
Liu F, Ichihara S, Valentine WM, Itoh K, Yamamoto M, Mohideen SS, Kitoh J, Ichihara G

1-Bromopropane (1-BP) was introduced as an alternative to ozone-depleting solvents. However, it was found to exhibit neurotoxicity, reproductive toxicity and hepatotoxicity in rodents and neurotoxicity in human. However, the mechanisms underlying the toxicities of 1-BP remain elusive. The present study investigated the role of oxidative stress in 1-BP-induced hepatotoxicity using nuclear factor erythroid 2-related factor 2 (Nrf2) null mice. Groups of 24 male Nrf2-null mice and 24 male wild type (WT) C57BL/6J mice were each divided into three groups of eight and exposed to 1-BP at either 0, 100 or 300 ppm for 8 hr/day for 28 days by inhalation. Liver histopathology showed significantly larger area of necrosis in Nrf2-null mice relative to WT mice at the same exposure level. Nrf2-null mice also had greater malondialdehyde (MDA) levels, higher ratio of GSSG/GSH and lower total glutathione content. The constitutional level and the increase in ratio per exposure level of glutathione S-transferase (GST) activity were lower in the liver of Nrf2-null mice than WT mice. Exposure to 1-BP at 300 ppm increased the mRNA levels of heme oxygenase-1 (HO-1), glutamate-cysteine ligase modifier subunit (GcLm), glutamate cysteine synthetase (GcLc), GR and NAD(P)H: quinone oxidoreductase 1 (NQO1) in WT mice, but not in Nrf2-null mice except for GST Yc2. Nrf2-null mice were more susceptible to 1-BP-induced hepatotoxicity. That oxidative stress plays a role in 1-BP hepatotoxicity is deduced from the low expression levels and activities of antioxidant enzymes and high MDA levels in Nrf2-null mice.

Microbial Spectrum and Primary Resistance to Rifampicin in Infectious Complications in Vascular Surgery: Limits to the Use of Rifampicin-Bonded Prosthetic Grafts.

Angiology. 2010 Mar 8;
Töpel I, Audebert F, Betz T, Steinbauer MG

There are reports that rifampicin-bonded prosthetic grafts might be a suitable alternative to autologous grafts in vascular graft infections and infectious vascular complications. We characterize the spectrum of microbial agents and susceptibility to antibiotic treatment, especially to rifampicin, in these patients. We carried out a retrospective analysis of wound-swaps and blood cultures in 48 patients with infected prosthetic vascular grafts or primary infectious vascular complications. In 15 of 48 patients (31%), the analysis showed that the microbial organism causing the infection was resistant or not susceptible to rifampicin. Rifampicin-bonded prosthetic grafts should be used with caution in acute infectious complications in vascular surgery, because in about 30% of the cases, the initiating microbial organisms are resistant or not susceptible to rifampicin. Without preoperative confirmation of susceptibility to rifampicin, autologous reconstruction should be preferred.

Relationships between emerging measures of heart failure processes of care and clinical outcomes.

Am Heart J. 2010 Mar; 159(3): 406-413
Hernandez AF, Hammill BG, Peterson ED, Yancy CW, Schulman KA, Curtis LH, Fonarow GC

BACKGROUND: Previous studies have not confirmed associations between some current performance measures for inpatient heart failure processes of care and postdischarge outcomes. It is unknown if alternative measures are associated with outcomes. METHODS: Using data for 20,441 Medicare beneficiaries in OPTIMIZE-HF from March 2003 through December 2004, which we linked to Medicare claims data, we examined associations between hospital-level processes of care and patient outcomes. Performance measures included any beta-blocker for patients with left ventricular systolic dysfunction (LVSD); evidence-based beta-blocker for patients with LVSD; warfarin for patients with atrial fibrillation; aldosterone antagonist for patients with LVSD; implantable cardioverter-defibrillator for patients with ejection fraction

Mechanisms of IgE-mediated allergy.

Exp Cell Res. 2010 Mar 5;
Rindsjö E, Scheynius A

Allergic diseases are a global health problem today. Knowledge is still lacking about what causes some people to develop allergies while others remain tolerant to environmental antigens. The recent increase in prevalence suggests an involvement of gene-environment interactions and epigenetic mechanisms. Since allergies often develop early in life, the intrauterine environment has been proposed to play a role in predisposing some individuals to become allergic. The development of techniques to produce allergens as highly pure recombinant proteins has improved the tools for allergy diagnosis and treatment. Novel strategies for allergen-specific immunotherapy include tailor-made vaccines and alternative routes for administration.

A liver X receptor (LXR)-beta alternative splicing variant (LXRBSV) is preferentially expressed in the pituitary.

Biochem Biophys Res Commun. 2010 Mar 5;
Hashimoto K, Ishida E, Miura A, Ozawa A, Shibusawa N, Satoh T, Okada S, Yamada M, Mori M

We have recently reported that an alternative splicing variant of liver X receptor (LXR)-beta acts as an RNA co-activator, which is referred to as LXRBSV. The in vivo role of LXRBSV is yet to be clarified. The LXRBSV gene is expressed in various tissues including the liver and brain. We evaluated the gene expression of LXRBSV in various regions of the brain using real-time quantitative PCR assays in the current study and found that LXRBSV is abundantly expressed in the pituitary. 5'-rapid amplification of cDNA ends (5'-RACE) revealed that the transcriptional start site (TSS) of LXRBSV is located 40 base pairs (bp) downstream of LXR-beta. We prepared two promoter constructs: -1565/+35bp and -1565/+75bp in pGL4 for LXR-beta and LXRBSV, respectively. The latter promoter construct demonstrated significantly higher activity than the former construct in GH3 cells derived from the rat pituitary. On the contrary, the promoter activities of these two constructs were indistinguishable in Hepa1-6 cells derived from mouse hepatocytes. Furthermore, the promoter region specific for LXRBSV itself exerted promoter activity in GH3 cells but not in Hepa1-6 cells. Taken together, we have concluded that LXRBSV is preferentially transcribed and expressed in the pituitary, indicating that LXRBSV plays a role in regulating pituitary gene expression. These data provide clues to elucidating the physiological relevance of LXRBSV.

Individualized chiropractic and integrative care for low back pain: the design of a randomized clinical trial using a mixed-methods approach.

Trials. 2010 Mar 8; 11(1): 24
Westrom KK, Maiers MJ, Evans RL, Bronfort G

ABSTRACT: BACKGROUND: Low back pain (LBP) is a prevalent and costly condition in the United States. Evidence suggests there is no one treatment which is best for all patients, but instead several viable treatment options. Additionally, multidisciplinary management of LBP may be more effective than monodisciplinary care. An integrative model that includes both complementary and alternative medicine (CAM) and conventional therapies, while also incorporating patient choice, has yet to be tested for chronic LBP. The primary aim of this study is to determine the relative clinical effectiveness of 1) monodisciplinary chiropractic care and 2) multidisciplinary integrative care in 200 adults with non-acute LBP, in both the short-term (after 12 weeks) and long-term (after 52 weeks). The primary outcome measure is patient-rated back pain. Secondary aims compare the treatment approaches in terms of frequency of symptoms, low back disability, fear avoidance, self-efficacy, general health status, improvement, satisfaction, work loss, medication use, lumbar dynamic motion, and torso muscle endurance. Patients' and providers' perceptions of treatment will be described using qualitative methods, and cost-effectiveness and cost utility will be assessed. Methods and Design This paper describes the design of a randomized clinical trial (RCT), with cost-effectiveness and qualitative studies conducted alongside the RCT. Two hundred participants ages 18 and older are being recruited and randomized to one of two 12-week treatment interventions. Patient-rated outcome measures are collected via self-report questionnaires at baseline, and at 4, 12, 26, and 52 weeks post-randomization. Objective outcome measures are assessed at baseline and 12 weeks by examiners blinded to treatment assignment. Health care cost data is collected by self-report questionnaires and treatment records during the intervention phase and by monthly phone interviews thereafter. Qualitative interviews, using a semi-structured format, are conducted with patients at the end of the 12-week treatment period and also with providers at the end of the trial. DISCUSSION: This mixed-methods randomized clinical trial assesses clinical effectiveness, cost-effectiveness, and patients' and providers' perceptions of care, in treating non-acute LBP through evidence-based individualized care delivered by monodisciplinary or multidisciplinary care teams. Trial registration: ClinicalTrials.gov NCT00567333.

Modified tenoscopic method for carpal flexor retinaculum release in a horse.

Vet Surg. 2010 Feb; 39(2): 239-43
Byron CR, Benson BM, Karlin WM, Stewart AA

Objective- To report the use of a proximolateral endoscopic portal with a distolateral instrument portal for carpal retinaculum release in a horse clinically affected with carpal canal syndrome. Study Design- Clinical report. Animals- A 4-year-old Thoroughbred female. Methods- Carpal canal syndrome secondary to traumatic suppurative tenosynovitis was treated by accessory carpal bone debridement and carpal retinaculum release using a tenoscopic approach to the carpal flexor synovial sheath through a proximolateral endoscope portal and a distolateral instrument portal. Results- Resolution of carpal sheath effusion and lameness occurred allowing racing 14 months later. Use of a distolateral instrument portal was not associated with complications or iatrogenic damage to neurovascular structures and reduced endoscope and instrument interference and offered easier access to the distal aspect of the carpal sheath. Conclusions- Carpal retinaculum release may be safely accomplished with a distolateral instrument portal when access to the distal aspect of the carpal sheath is needed. Clinical Relevance- The distolateral instrument portal described may be a useful alternative to a proximolateral portal when distal carpal sheath instrument access is necessary or advantageous.

Epididymis ligation: a minimally invasive technique for preparation of teaser rams.

Vet Surg. 2010 Jan; 39(1): 121-7
Tamadon A, Nikahval B, Sepehrimanesh M, Mansourian M, Naeini AT, Nazifi S

Objective- To describe a minimally invasive technique for preparation of teaser rams by needle-assisted ligation through the tail of the epididymis. Study Design- Experimental study. Animals- Mature rams (n=6), estrus-induced ewes (2). Methods- After local anesthesia, epididymis ligation was achieved by restraining the testis distally within the scrotal sac and passing suture through a hypodermic needle inserted between tail of epididymis and distal pole of testis, caudomedial to craniolateral through the scrotum. The needle was removed leaving the suture in place and the testis pushed up dorsally, then the needle was reinserted through the original holes and the suture passed back through the needle, which was withdrawn. This resulted in the suture forming a complete loop around the epididymis. The suture ends were tied ligating the epididymis. Semen was evaluated pre- and postligation. Testes were removed after 30 days for gross and histologic examination. Results- Epididymis ligation was accomplished without postoperative complications. Three weeks after the epididymis ligation, no motile and live spermatozoa were found in ejaculates. From 5 to 28 days after epididymis ligation, attraction to ewes and libido was unchanged and similar to 14 days before ligation. Conclusions- This novel minimally invasive technique is a simple, alternative method for preparation of teaser rams. Clinical Relevance- This method is simply performed, without skin wounds, and minimal postoperative care is needed. The technique should be readily adaptable to other species.

Mechanical evaluation of hydrogen peroxide gas plasma sterilization of nylon lines used for extra-articular stabilization of the canine stifle joint.

Vet Surg. 2010 Jan; 39(1): 48-53
Gatineau M, Huneault L, Lussier B, Lefevre-Lavoie J

Objective- To compare the effects of hydrogen peroxide gas plasma (HPGP) and ethylene oxide (EO) sterilizations on the mechanical properties of nylon lines used for stabilization of the canine stifle. Secondarily, to compare the performance of crimped and knotted lines. Study Design- In vitro mechanical evaluation. Sample Population- Nonsterilized, EO- and HPGP-sterilized specimens of 36.3 kg test nylon leader line (NLL) and 57.8 kg test nylon fishing line (NFL). Methods- Single strands and looped specimens of NLL or NFL were positioned on a material testing machine. To create looped specimens, NLL were crimped using the Securos system, and NFL were knotted, as used clinically. Elongation (%) and ultimate load (N) variables were studied. Results- Elongation and ultimate load of NLL groups were not significantly different between EO and HPGP. For NFL, HPGP sterilization led to slightly greater elongation than EO in loops only. Ultimate load of NFL single strands was not significantly different between EO and HPGP, but was higher after HPGP compared with EO in NFL loops. All NLL groups had less elongation and ultimate load than NFL. Conclusion- The effects of HPGP on NLL compared positively to EO, making HPGP an attractive alternative. As HPGP led to a slightly greater elongation of NFL than EO, the latter could be favored to sterilize NFL. Crimped NLL minimized elongation better than knotted NFL. Clinical Relevance- Sterilization with HPGP seems a good alternative to EO for NLL. EO may be a better choice for NFL; however, it is difficult to judge the clinical relevance of this result. Crimped NLL minimizes elongation and may help reducing the recurrence of stifle instability postoperatively.

Z-DNA Binding Proteins as Targets for Structure-Based Virtual Screening.

Curr Drug Targets. 2010 Mar 1; 11(3): 335-44
Kim D, Lee YH, Hwang HY, Kim KK, Park HJ

Z-DNA, the alternative form of double-stranded DNA involved in a variety of nucleotide metabolism, is recognized and stabilized by specific Z-DNA binding proteins (ZBPs). Three ZBPs known in vertebrates -ADAR1, DAI and PKZ- modulate innate immunity, particularly, the IFN-induced immune response. The E3L protein of the vaccinia virus appears to compete with the host ZBP for Z-DNA binding, thereby suppressing the host immune system. ZBPs are, therefore, considered to be attractive therapeutic targets for infectious and immune diseases. Recent advances in computer-aided drug development combined with the high-resolution crystal and NMR structures of ZBPs have enabled us to discover novel candidates as ZBP inhibitors. In this study, we present an overview of Z-DNA and known ZBPs as drug targets, and summarize recent progress in the structure-based identification of ZBP inhibitors.

Efflux-Pump-Derived Multiple Drug Resistance to Ethambutol Monotherapy in Mycobacterium tuberculosis and the Pharmacokinetics and Pharmacodynamics of Ethambutol.

J Infect Dis. 2010 Mar 8;
Srivastava S, Musuka S, Sherman C, Meek C, Leff R, Gumbo T

Background. Ethambutol is used for the treatment of tuberculosis in cases where there is isoniazid resistance. We examined the emergence of drug resistance to ethambutol monotherapy in pharmacokinetic-pharmacodynamic studies of a hollow-fiber system. Methods. Dose-effect and dose-scheduling studies were performed with ethambutol and log-phase growth Mycobacterium tuberculosis to identify exposures and schedules linked to optimal kill and resistance suppression. In one study, after 7 days of daily ethambutol, 300 mg isoniazid per day was administered to each system to determine its early bactericidal activity. Results. Efflux-pump blockage reduced the mutation frequency to ethambutol 64-fold. In dose-effect studies, ethambutol had a maximal early bactericidal activity of 0.22 log(10) colony-forming units/mL/day, as is encountered in patients. By day 7, resistance to both ethambutol and isoniazid had increased. Previous exposure to ethambutol halted isoniazid early bactericidal activity. Daily therapy, as opposed to more intermittent therapy, was associated with the least proportion of efflux-pump-driven resistance, consistent with a time-driven effect. Microbial kill was best explained by the ratio of area under the concentration-time curve to minimum inhibitory concentration ([Formula: see text]). Conclusion. The induction of an efflux pump that reduces the effect of multiple drugs provides an alternative pathway to sequential acquisition of mutations in the development of multiple drug resistance.

Efficacy and feasibility of radiofrequency ablation for liver metastases from gastric adenocarcinoma.

Int J Hyperthermia. 2010 Mar 8;
Kim HR, Ha Cheon S, Lee KH, Ryun Ahn J, Jeung HC, Sook Lee S, Cheol Chung H, Hoon Noh S, Young Rha S

Purpose: Optimal treatment for liver metastases from gastric cancer remains a matter of debate. The aim of our study is to evaluate the efficacy of radiofrequency ablation (RFA) for the treatment of liver-only metastases from gastric adenocarcinoma. Materials and methods: We retrospectively reviewed medical records of 29 patients who developed liver-only metastases from gastric adenocarcinoma and subsequently underwent gastric resection and RFA (n = 20) or gastric resection and systemic chemotherapy (n = 9) between January 1995 and February 2008. Overall survival was estimated using the Kaplan-Meier method, and was compared using the log rank test to evaluate RFA efficacy. Results: Twenty patients who underwent RFA showed a median overall survival of 30.7 months (range: 2.9 to 90.9 months), a median progression-free survival of 6.8 months (range: 0.8 to 45.2 months), and median overall one-, three-, and five-year survival rates were 66.8%, 40.1%, and 16.1% respectively. The RFA group showed a 76% decreased death rate compared to the chemotherapy-only group (30.7 months versus 7 months, hazard ratio, 0.24; p = 0.004). Most patients tolerated RFA well, and complications were found to be minor (transient fever (20%) and/or right upper quadrant pain (25%)). One case of treatment-related death occurred due to sepsis that originated from a liver abscess at the ablation site. Conclusions: The data suggest that a use of RFA as a liver-directed treatment may provide greater survival benefit than chemotherapy and is an alternative option for the treatment of liver-only metastases from gastric cancer.

The impact of non-fee-for-service reimbursement on chronic disease surveillance using administrative data.

Can J Public Health. 2009 Nov-Dec; 100(6): 472-4
Alshammari AM, Hux JE

OBJECTIVE: Use of physician service claims and other administrative data is increasingly being advocated for chronic disease surveillance. However, such data may be vulnerable to reimbursement policy changes. We sought to determine how non-fee-for-service (non-FFS) primary care affects the detection of diabetes using physician claims data. METHODS: Ontarians over age 66 with diabetes and receiving care in a non-FFS setting were identified using prescription claims for glucose-lowering drugs written by non-FFS physicians. We compared the date of incident treatment in this cohort with the diagnosis date in the Ontario Diabetes Database, a validated administrative data algorithm to detect persons with diabetes. We assessed the rate of detection and, among detected cases, whether detection was late (more than 6 months after the index prescription). Survival methods were used to assess detection over time. RESULTS: Only 49.7% of prescription-defined diabetes cases were detected within six months of the index prescription; 23.7% remained undetected after up to nine years of follow-up. Detected individuals had higher rates of hospitalization for vascular complications than missed cases (15.1% vs 4.8%, p < 0.0001), suggesting that they were at a more advanced stage of disease. CONCLUSIONS: Non-FFS reimbursement arrangements for primary care physicians appear to undermine the utility of administrative data for chronic disease surveillance, leading to both decreased sensitivity and biased detection. Provisions for alternative means to collect diagnostic information should be considered as these arrangements are introduced.

Utilization and Practice of Traditional/Complementary/Alternative Medicine (TM/CAM) in South Africa.

Afr J Tradit Complement Altern Med. 2009; 6(2): 175-85
Peltzer K

The aim of this study was to conduct a systematic review of published and unpublished research investigating the prevalence of traditional, complementary and alternative medicine (TMCAM) use in the general population. Results found that use of a traditional and/or faith healer seemed to have decreased over the past 13 years (from a range of 3.6-12.7% to 0.1%). The prevalence of traditional male circumcision was found to be 24.8% generally and 31.9% among the African Black racial group. The range of use of alternative and complementary medicine was from 0% to 2.2%. Local utilization surveys of TMCAM for the last illness episode or in the past year showed a variation in use of 6.1% to 38.5%. The prevalence of conditions treated at different TMCAM out-patients settings ranged from chronic conditions, complex of supernatural or psychosocial problems, mental illness, chronic conditions, acute conditions, generalized pain, HIV and other sexually transmitted infections. TM and probably CAM is used by substantial proportions of the general population, but differences in study design and methodological limitations make it difficult to compare prevalence estimates.

The value of D-dimer test in the diagnosis of patients with nontraumatic acute abdomen.

Ulus Travma Acil Cerrahi Derg. 2010 Jan; 16(1): 22-26
Akyıldız HY, Sözüer E, Akcan A, Küçük C, Artis T, Biri I, Yılmaz N

BACKGROUND: A patient with acute abdominal pain requires rapid evaluation. In these patients, it is very important to distinguish between surgical and nonsurgical pathology. Our aim was to compare the accuracy of the leukocyte count and D-dimer test in the diagnosis of acute abdomen. METHODS: In this prospective study, 225 patients admitted to the emergency unit due to nontraumatic acute abdomen between June 2006 and November 2007 were evaluated. The patients were divided into two groups: Group 1 patients who needed immediate laparotomy and Group 2 patients who did not. Age, gender, leukocyte count, D-dimer level, causes of acute abdominal pain, and operative findings were investigated. P values of <0.05 were considered statistically significant. RESULTS: There was a positive correlation between the plasma D-dimer level and leukocyte count. D-dimer acted similarly to the leukocyte count in emergency abdominal conditions. The area under the receiver operating characteristic curve was statistically higher with the D-dimer test (p<0.0001). Additionally, in patients needing immediate laparotomy, the sensitivity of the D-dimer test was 95.7% versus 74.8% for leukocyte counts. CONCLUSION: In a patient with acute abdomen, D-dimer test may be a strong alternative or an adjuvant to the leukocyte count.

[Complementary and Alternative Medicines: a meta-synthesis.]

Cad Saude Publica. 2010 Jan; 26(1): 7-13
Spadacio C, Castellanos ME, Barros NF, Alegre SM, Tovey P, Broom A

The growing use of Complementary and Alternative Medicines (CAM) has led to an increase in the number of qualitative studies on the subject, thus justifying a meta-synthesis of the resulting material. The current article presents a systematic review of qualitative studies on CAM published in international journals. The review was conducted according to the meta-synthesis methodology. A search was performed in journals through the Periodicals Periodical of CAPES, the National Agency for the Evaluation of Graduate Studies, and 32 articles were selected for analysis. The reviewed studies raise questions focusing on: patients, their therapeutic experiences, and their social and cultural contexts; professionals, professional relations, and the process of professionalization of CAM; and CAM and their relationship to biomedicine. The article concludes that qualitative studies on CAM call for an exploratory view of the theme, seeking to identify the experiences of patients and professionals with these therapies and discussing the impact of their use on conventional medicine or biomedicine.