Omega 3 and Heart disease

The study was a systematic review of 48 randomised controlled trials (RCTs) and 41 analyses of 26 cohort studies, which investigated the effects of omega 3 fats on mortality, cardiovascular disease, cancer, and stroke.

RCTs and cohort studies of adult populations who were not critically ill, with a duration of at least six months and data relating to mortality, cardiovascular events or cancer were included.

The review examined the effects of long and shorter chain omega 3 fatty acids. In the RCTs, these were given as dietary supplements, advice to eat oily fish, or a combination of food supplements and dietary advice together. In the cohort studies, intake of omega 3 was assessed by dietary and biochemical means.

Pooled results of 34 RCTs found no statistically significant reduction in mortality with omega 3. This was still the case when only the higher quality RCTs were analysed. The risk of death was found to increase as the duration of the RCTs increased. The less stringent cohort studies suggested that omega 3 significantly reduced mortality. However, it was unclear if adequate adjustments were made for potential confounding factors.

Neither the RCTs nor cohort studies found any clear evidence that omega 3 has an effect on cardiovascular events, cancer or bleeding outcomes.

The authors concluded that there is no clear evidence that long chain or shorter chain omega 3 fats have an effect on mortality, cardiovascular events, or cancer, and it is probably not appropriate to recommend high doses of omega 3 fats for people who have angina. The authors stated that they do not rule out an effect of omega 3 on mortality, and that current UK advice to eat more oily fish should continue, with regular review of the evidence.

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Spinal manipulation for medical problems

The study was a systematic review of sixteen systematic reviews published between 2000 and May 2005. A total of 239 studies, assessing spinal manipulation in a variety of medical conditions (back pain, neck pain, non-spinal pain, primary and secondary dysmenorroea, infantile colic, asthma, allergy, cervicogenic dizziness, and any medical problem) were included.

The reviews included any type of spinal manipulation, spinal manipulation and mobilization, chiropractic spinal manipulation, physiotherapy and/or spinal manipulation, or manual therapy

The authors presented excerpts from the conclusions made in each of the included studies. The majority of the reviews concluded that there was no evidence that spinal manipulation is effective, or that spinal manipulation is more effective than other treatments. However, one review showed that spinal manipulation is better than sham therapy for low back pain, and another concluded that when combined with exercise, spinal manipulation can be effective in reducing back pain, but is not as effective as a single treatment. Another review concluded that spinal manipulation is better than massage, and produces an effect similar to that of prophylactic drugs for headache, and another concluded that spinal manipulation and/or mobilisation are possible treatment options for low back and neck pain. None of the reviews found conclusive evidence that spinal manipulation is ineffective.

The authors concluded that there is no evidence that spinal manipulation is effective for any of the conditions examined, except for back pain. Given the possibility of adverse effects, the review does not support the use of spinal manipulation.

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Salicylate poisoning

This from the US Guidelines clearinghouse. The higher the grade, the better the evidence, with A as best.

Patients with administration of an overdose of salicylate should be referred to an emergency department. This referral should be guided by local poison centre procedures, regardless of the dose reported (Grade D).

The presence of typical symptoms of salicylate toxicity such as hematemesis, tachypnea, hyperpnea, dyspnea, tinnitus, deafness, lethargy, seizures, or less commonly unexplained lethargy, confusion, or dyspnea warrants referral to an emergency department for evaluation (Grade C).

Patients who exhibit typical symptoms or non-specific symptoms such as unexplained lethargy, confusion, or dyspnea, which could indicate the development of chronic salicylate toxicity, should be referred to an emergency department (Grade C).

Patients without evidence of self-harm should have further evaluation, including determination of the dose, time of ingestion, presence of symptoms, history of other medical conditions, and the presence of co-ingestants. The acute ingestion of more than 150 mg/kg or 6.5 g of aspirin equivalent, whichever is less, warrants referral to an emergency department. Ingestion of greater than a lick or taste of oil of wintergreen (98% methyl salicylate) by children under 6 years of age and more than 4 mL of oil of wintergreen by patients 6 years of age and older could cause systemic salicylate toxicity and warrants referral to an emergency department (Grade C).

Do not induce emesis for ingestions of salicylates (Grade D).

Consider administration of activated charcoal for acute ingestions of a toxic dose, if  no contraindications are present, the patient is not vomiting, and local guidelines for its out-of-hospital use are observed. However, do not delay transportation to administer activated charcoal (Grade D).

Women in the last trimester of pregnancy who ingest below the dose for emergency department referral and do not have other referral conditions should be directed to their primary care physician, obstetrician, or a non-emergent health care facility for evaluation of maternal and foetal risk. (Grade C).

For asymptomatic patients with dermal exposures to methyl salicylate or salicylic acid, the skin should be thoroughly washed with soap and water and the patient can be observed at home for development of symptoms (Grade C).

For patients with an ocular exposure of methyl salicylate or salicylic acid, the eye(s) should be irrigated with room-temperature tap water for 15 minutes. If after irrigation the patient is having pain, decreased visual acuity, or persistent irritation, referral for an ophthalmologic examination is indicated (Grade D).

Poison centres should monitor the onset of symptoms whenever possible by conducting follow-up calls at periodic intervals for approximately 12 hours after ingestion of nonenteric-coated salicylate products and for approximately 24 hours after the ingestion of enteric-coated aspirin (Grade C).

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