Integrative tumor board: metastatic breast cancer.
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Acupuncture Therapy↗
Biomedical subjects
Noah Samuels
Publications and source records attributed to Noah Samuels.
Routine testing for IgG antibodies against hepatitis A virus in Israel.
BACKGROUND: Viral hepatitis is highly endemic in Israel, with the hepatitis A virus (HAV) responsible for most cases. Improved socioeconomic factors, as well as the universal vaccination of infants (introduced in 1999) has resulted in a decline in infection rates in Israel. This study examines the benefits of routine testing for anti-HAV IgG in high-risk population. METHODS: A retrospective examination of the files of teenage and adult patients (aged 16-99 years; mean 33.9) in two primary care clinics found 1,017 patients who had been tested for anti-HAV IgG antibodies for either general healthcare screening or ongoing follow-up for chronic illness. Seropositive patients were then asked regarding recall of past hepatitis (i.e. jaundice, regardless of viral etiology); post-exposure prophylaxis with immune serum immunoglobulin (ISG); and active immunization with inactivated virus. Seronegative patients were subsequently sent for active immunization. RESULTS: Of the 1,017 patient records studied (503 male, 514 female), a total of 692 were seropositive (354 males, 338 females; P = 0.113). Seropositivity rates increased with age (p < 0.005), and were highest among those born in Middle Eastern countries other than Israel (91.3%) and lowest among immigrants from South America (44.1%; P < 0.005). 456 of the seropositive patients were interviewed, of whom only 91 recalled past illness while 103 remembered receiving post-exposure prophylaxis (ISG) and 8 active vaccination. Those who were unaware of past infection were more likely to have been vaccinated with ISG than those who were aware (26.3% vs. 7.7%; p < 0.005). CONCLUSION: The relatively high prevalence rate of anti-HAV seropositivity in our study may me due to the fact that the study was conducted in a primary care clinic or that it took place in Jerusalem, a relatively poor and densely populated Israeli city. Most of the seropostive patients had no recollection of prior infection, which can be explained by the fact that most hepatitis A infections occur during childhood and are asymptomatic. Routine testing for anti-HAV IgG in societies endemic for HAV would help prevent seropositive patients from receiving either post-exposure or preventive immunization and target seronegative patients for preventive vaccination.
Adolescent↗
Integration of hypnosis with acupuncture: possible benefits and case examples.
Acupuncture treatment uses ultrafine needles which are inserted into specified points on the skin (acupoints). Acupuncture can help alleviate pain and inflammation, possibly through the increased release of pituitary beta-endorphins and ACTH. Hypnosis can also help alleviate pain syndromes, and may have centrally mediated immunomodulatory effects. The use of these 2 treatments simultaneously may potentially assist and augment the effects of each another. Two case reports where both treatments are used together are presented: One showing how hypnosis can help in the treatment of painful acupoints, the other how the response to acupuncture may be augmented by hypnosis in the treatment of headache. Controlled trials of this combined treatment are warranted.
Acupuncture Therapy↗
Herbal remedies and anticoagulant therapy.
Herbal remedies, considered to be both safe and effective by most consumers, may interact with conventional drugs. Warfarin, a vitamin K antagonist originally derived from the sweet clover plant, has a narrow therapeutic window which can be monitored using prothrombin international normalized ratios (PT-INR). Many herbs can increase the risk for bleeding when combined with warfarin, either by augmenting the anticoagulant effects of the drug (with increased PT-INR levels) or through intrinsic anti-platelet properties (without altering PT-INR levels). The increased risk for bleeding among such patients may be difficult to predict, especially when formulas which contain many herbs are used. Further research into herb-drug interactions is warranted, as are guidelines for the use of herbal remedies by patients on chronic anticoagulation therapy.
Anticoagulants↗
Screening for homocysteine levels in Israel in primary care clinics: a need for guidelines.
BACKGROUND: Elevated total homocysteine (tHcy) levels (>/= 15 micromol/L), resulting from enzyme or vitamin deficiency, increase risk for cardiac, cerebral, and peripheral vascular disease. This study examines tHcy levels in an Israeli population and the relationship to vitamin status and disease. The need for screening guidelines is discussed. METHODS: Fasting blood was tested for tHcy levels in 262 patients (141 male, 121 female) presenting to two primary care clinics. Levels of folic acid and vitamin B12 were examined as well. RESULTS: Elevated tHcy levels (>/= 15 micromol/L) were found in 43 of the males (30.5%) and four of the female patients (3.3%, P < 0.005), while females had higher levels of both vitamin B12 and folic acid. Those with elevated tHcy levels tended to be older and with lower vitamin levels, with a higher frequency of coronary artery disease. CONCLUSIONS: Screening for tHcy and fortification of grain products with folic acid is a cost-effective means for preventing disease. Serum tHcy levels are inversely related to vitamin status, and higher levels among males is thought to be due to metabolic differences between the genders. Guidelines for screening for tHcy in Israel should be established, and fortification of grain products implemented.
Adolescent↗
Acupuncture for acute torticollis: a pilot study.
The use of subjective end-points such as VAS pain scales in studies of acupuncture for chronic neck pain have resulted in equivocal results. This study introduces an objective parameter as the primary end-point for the assessment of acupuncture in patients with acute torticollis (stiff neck). Eighteen patients underwent a single 20-minute treatment session, with needling of two acupuncture points Hou Hsi (SI-3) and Luo Zhen (M-UE-24), on the side ipsilateral to the predominantly involved side of the neck. Measuring the angle of lateral head rotation using a simple compass and protractor, a mean improvement of 52.9% was found, more so among those presenting earlier (< 24 hours) as opposed to later (> 72 hours; p = 0.034). The use of objective parameters, as seen in acupuncture research of the gastrointestinal and respiratory tracts, should be incorporated into studies of acute and chronic neck pain. The use of sham needle points and placebo needles is problematic since both may elicit physiological responses.
Acupuncture Points↗
[Acupuncture for nausea: how does it work?].
Nausea, the unpleasant feeling that one is going to vomit, results from the stimulation of the Chemoreceptor Trigger Zone (CTZ) and Vomiting Center in the brain. Conventional medical therapy is not always effective, and medications often have severe adverse effects. Acupuncture is a treatment in which thin needles (diameter of 0.20-0.30 mm) are inserted into various points along the skin, according to energy channels (meridians) established thousands of years ago. The anti-emetic effects of acupuncture apparently stem from the resultant increase in hypophyseal secretion of beta-endorphins and ACTH, with subsequent inhibition of the CTZ and vomiting center. Acupuncture also affects the upper GI tract, decreasing acid secretion and repressing gastric arrhythmias. Clinical research has found this treatment modality to be effective for nausea, whether it be due to morning sickness in pregnant women, motion sickness in travellers, postoperative nausea or chemotherapy-induced nausea in cancer patients.
Acupuncture Points↗
Treatment of migraine.
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Acupuncture Therapy↗
[Acupuncture for cancer patients: why not?].
Acupuncture is a complementary medical treatment whose use in cancer patients has been recommended by the American Cancer Society (ACS) for the treatment of cancer and treatment-related symptoms. Pain, nausea, breathlessness, vasomotor symptoms and limb edema have all been found to respond to this treatment modality. Accordingly to traditional Chinese medicine (TCM), acupuncture "disperses" the stagnation of energy which is thought to cause the tumor to form. As such, many acupuncturists are unwilling to treat cancer patients for fear of "dispersing" the tumor, as well as further compromising patients' immunity with this immunosuppressive treatment modality. Though it is true that care should be taken not to insert acupuncture needles in the vicinity of the tumor, there is no reason to fear "dispersal" of the tumor when using distant points, since this concept is one of TCM and not conventional medicine. In addition, the immunomodulatory effects of acupuncture, both via the release of pituitary beta-endorphin and ACTH, as well as alleviating patient stress through relief of symptoms, are anti-carcinogenic. The medical establishment in Israel should consider recommending acupuncture for cancer patients.
Acupuncture Therapy↗