BioMed Central Blog

Bipolar disorder: mind and body

This guest blog is written by Dr Georgina Hosang, who is an ESRC/MRC Interdisciplinary Postdoctoral Fellow from the MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London. Her research focuses on understanding the role of life stress in bipolar disorder and major depression and their interaction with genetic factors. 

In the spirit of Mental Health Awareness Week from 21 to 27 May 2012 and new developments discussed at the international society of bipolar disorders earlier this year, bipolar disorder is the topic of discussion. This is a serious psychiatric illness characterised by extreme fluctuations in mood, ranging from depression to elation or irritability (hypomania or mania), sometimes accompanied by psychotic features (e.g. hallucinations and delusions).

Bipolar episodes are highly recurrent which can be extremely disabling and cause much distress to the individual and their families. For example, it is associated with impaired work performance and relationship dysfunction as well as premature mortality. Broadly defined the disorder affects 2.4% of the population worldwide, including a number of successful public figures, such as Stephen Fry and Frank Bruno, who have spoken openly about their illness and experiences. They are good examples of individuals with bipolar disorder who successfully manage their illness and make a significant contribution to society.

Adding to such burden is the increasing recognition of the high rates of medical conditions among people with bipolar disorder (and other psychiatric illnesses). Suffering from mental and physical illnesses simultaneously can be stressful and traumatic, impacting on recovery and management of both conditions. This phenomenon creates many complications for practitioners, particularly for detection and diagnosis of physical illnesses. Providing effective treatment for both groups of disorders can be especially challenging for health care professionals. Against this background the high impact of the comorbidity between physical and mental illnesses has been acknowledged by the UK Government through their ‘No health without mental health’ strategy'.

The factors which contribute to the comorbidity between bipolar disorder and physical illnesses are largely unknown. Side effects of long-term psychotropic medication use, genetic influences and unhealthy lifestyle choices (e.g. poor diet and lack of exercise) have been highlighted as likely culprits. Our limited understanding of the mechanisms and risk factors which lead to the co-occurrence of physical and mental illnesses heralds a new era of research. Researchers are investing much effort in this plight and upcoming results promise to progress the field and will hopefully lead to the development of more effective intervention and treatment strategies improving the lives of many bipolar disorder patients.

Posted by Ursula D'Souza at 17:13    Comments (0)

Interventions given during pregnancy improve outcome for obese women

The incidence of maternal obesity is on the rise, with one in five pregnant women estimated to be obese. This poses great risk for both mother and baby; obese women are more likely to develop gestational diabetes and gestational hypertension than mothers of normal weight, and pregnant women with extreme obesity are at 1.6 times greater risk of suffering a premature birth. Maternal obesity is also associated with  increased risk of miscarriage, congenital abnormalities and long-term health risks for the baby, including autism and obesity in future generations.

The National Institute for Health and Clinical Excellence (NICE) has issued guidance recommending that healthcare professionals educate women on the health risks of obesity during pregnancy. Guidance is mainly focused on weight loss when planning a pregnancy, and it is recommended that women have a balanced diet combined with an active lifestyle. However, around 50% of pregnancies are unplanned, highlighting the importance of weight-loss interventions during pregnancy.

In a systematic review and meta-analysis published in BMC Medicine, Oteng-Ntim and colleagues show that lifestyle interventions during pregnancy are associated with improved pregnancy outcome. The study analysed published randomised controlled trials (RCTs) and non-RCTs including individual and group-based dietary and exercise interventions. The authors found that interventions are associated with a reduction in maternal weight gain and prevalence of gestational diabetes, suggesting that interventions during pregnancy are beneficial. However, there were no significant effects on other outcomes, including caesarean delivery and birth weight. 

The study by Oteng-Ntim and colleagues shows that lifestyle interventions during pregnancy can be used to reduce adverse maternal outcomes, and highlights that more high-quality trials are needed to assess the effect on infant outcomes.  Following this insightful study, future research should address whether following diet and exercise recommendations during pregnancy reduces birth weight and caesarean delivery; Oteng-Ntim and colleagues showed that studies investigating these outcomes were of low quality. If future research yields positive results, interventions targeting obesity in pregnant women could be offered routinely to improve both maternal and infant pregnancy outcomes.

Posted by Claire Tree-Booker at 10:00    Comments (1)

Neglected tropical diseases: incorporating nutrition into control programs

Neglected tropical diseases (NTDs) are a group of poverty-associated chronic infectious diseases, which are endemic in poor and rural populations in the developing countries of Africa, America and Asia. NTDs affect over 1.4 billion people worldwide and cause severe morbidity and mortality; their impact in sub-Saharan Africa is comparable to malaria or tuberculosis. The diseases, which include river blindness, leprosy and intestinal worms, are transmitted by insect bites or worms in the soil, and are easily spread in areas with poor sanitation.

Worldwide action against NTDs has accelerated since 2007, when the World Health Organization (WHO) held the first global partners’ meeting on NTDs. There are effective drugs to treat these infections, but international efforts are required to distribute treatments, and there are a shortage of healthcare workers in poor countries. The first WHO report on NTDs, released in 2010, highlighted the progress made in the fight against these diseases; pharmaceutical companies agreed to provide many preventive chemotherapy drugs free of charge, with 705 million people reached in 2009. Progress has also been made in transmission control using pesticides, and in increased access to safe drinking water.

However, the fight is far from over; the WHO report listed the remaining challenges that must be overcome, which include provision of sanitation for all people and addressing the problem of drug resistance. Following this report, the UK government announced more funding for the fight against NTDs at the beginning of 2012, and has agreed an action plan to combat them over the next decade together with pharmaceutical companies, the WHO and the US government. The action plan involves a dramatic increase in drug treatment programs, and aims to eliminate a number of the NTDs, including sleeping sickness and leprosy, by 2020.

In addition to drug control programs, there has recently has been an increasing focus on the nutritional aspects of NTDs. Because NTDs are prevalent in poor populations, they predominantly affect those who suffer from chronic undernutrition. In an opinion article published in BMC Medicine, Andrew Hall and colleagues from the University of Westminster in collaboration with Helen Keller International argue that nutritional intervention programs must be added to chemotherapy to receive the full benefit of treatment. Hall and colleagues describe how drug treatment cannot be fully effective without adequate nutrients to repair damage to the body. Additionally, undernutrition increases susceptibility to infection with NTDs and reduces resistance, and drug treatment alone cannot prevent re-infection with helminths in undernourished individuals. NTDs also cause loss of nutrients themselves; helminth infections give rise to malabsorption, and trichuriasis causes gut inflammation and lack of appetite. 

To break away from the cycle of undernutrition and NTD infection, Hall and colleagues propose an integrated control program that includes drug treatment, nutritional rehabilitation and measures to prevent re-infection. As there is potential for nutritional intervention to be added to drug treatment programs, the authors suggest that this could be done relatively easily to restore health in those affected by NTDs.

The study by Hall and colleagues may influence the delivery of NTD control programs in the future. Adding nutritional interventions to the current efforts to combat NTDs could further increase the effectiveness of control programs and add to global efforts to eliminate many NTDs by the end of the decade.

Posted by Claire Tree-Booker at 17:37    Comments (1)

BioMed Central attends the AACR Annual Meeting

Between the 31^st March and the 4^th April 2012, BioMed Central attended the Annual Meeting  of the American Association for Cancer Research (AACR),the oldest and largest cancer research organization in the world, in Chicago, Illinois.  The theme of this year’s meeting was “Accelerating Science: Concept to Clinic” and more than 16,000 attendees were treated to talks covering all aspect of basic, translational and clinical cancer research.  The AACR conference was an ideal showcase for BioMed Central’s portfolio of Cancer journals, which includes Breast Cancer Research, Molecular Cancer and BMC Cancer, along with BMC Medicine, the flagship medical journal of the BMC-series.

We were delighted to meet Francesco Marincola, Editor-in-Chief of Journal of Translational Medicine, which has enjoyed continued success over the past year and whose talk on the immunological constant of rejection in cancer proved to be very interesting.  We were also able to meet the Editors of BioMed Central’s two newest cancer journals – Chung-Tsen Hsueh, Deputy Editor-in-Chief of Experimental Hematology & Oncology, and Chi Van Dang, Editor-in-Chief of the upcoming Cancer & Metabolism.  BMC Cancer was pleased to meet several of its dedicated academic Section Editors and Associate Editors at the exhibition stand and also at the editorial board meeting, which was held during the conference.  We would also like to take this opportunity to thank Danny Dhanasekaran, Editor-in-Chief of Journal of Molecular Signalling, Sham Kakar, Editor-in-Chief of Journal of Ovarian Research, and everyone who took the time to visit us at the booth.  

The meeting opened with an interesting talk by Elaine Mardis about how genomic changes in tumors can be used to monitor response to treatment, and a central theme linking many speakers’ presentations was how cancer medicine is moving away from tumor-specific treatment and towards targeted therapy, in a more personalized approach. Rakesh Jain described how the tumor microenvironment can be modified to enhance the response to therapy in the session “Tumor heterogeneity: challenges and therapeutic opportunities”, and Avrum Spira gave a thought-provoking presentation on identifying lung cancer risk genes before the development of disease, so that early interventions can be carried out.  The “Current concepts and controversies in diagnostics, therapeutics, and prevention” session was concluded by a very stimulating talk by BMC Cancer’s Associate Editor David Malkin on the application of genomics to the development of clinical surveillance and treatment guidelines for children deemed to be at ‘high risk’ for cancer.

We hope to see you at the 2013 meeting in Washington, DC.

Posted by Philip Dooner at 09:25    Comments (0)

Revealing the role of ApoE alleles in epilepsy and risk of Alzheimer’s Disease

Epilepsy is a common neurological disorder, affecting 50 million people worldwide, and is characterized by the tendency to have recurrent unprovoked seizures due to abnormal neuronal activity in the brain. Epilepsy affects people of all ages, yet interestingly, it is also associated with the precocious development of Alzheimer’s Disease (AD)-type neuropathological changes, such as the accumulation of amyloid-β (Aβ) as senile plaques and increased microglial activation compared to healthy individuals. AD itself mostly affects older people, with onset typically occurring from the age of 65 years.

It is known that there is a genetic predisposition to AD, so that individuals carrying two copies of the Apolipoprotein E (ApoE) variant epsilon 4 have a much higher risk of developing the disease than those with other variants of this gene. But why is this?

In a research article recently published in BMC Medicine, Sue Griffin and colleagues elucidate the mechanism behind this using a remarkably simple yet clever model. Using temporal lobe tissue removed from the brains of temporal lobe epilepsy (TLE) patients as part of their treatment, the research team were able to investigate the physiological effects of various ApoE genetic variants on the brain tissue, while at the same time avoiding the confounding factors that would come with investigating these effects in AD patients’ brains. For instance, looking at tissue from younger brains meant that there were likely to be very few age-related changes.

The research team looked at  different markers of neuronal injury and resilience in brain tissue derived from patients that had two copies of the episilon 4 variant and compared them to those that that two copies of the episilon 3 variant. They found that the episilon 4 variant is not only associated with an increased burden of Aβ plaques, but is also associated with a compromised ability to combat the neuronal toxicity of these plaques. In contrast, the episilon 3 variant was associated with neuroprotection, meaning that carriers of this variant are less likely to be adversely affected by AD changes.

Posted by Lin Lee at 10:55    Comments (0)

New insights in emergency medicine

Emergency medicine represents an umbrella group of disciplines that aims to diagnose and treat acute and life-threatening conditions as well as ensuring that long term outcomes are not adversely affected. Advances in this important field were highlighted recently at the International symposium on Intensive Care and Emergency Medicine (ISICEM), which was attended by BMC Medicine. ISICEM is one of the largest emergency medicine conferences, and, with key opinion leaders discussing cutting edge science, it attracted over 5000 delegates in Brussels where it was held this year.

Topics were diverse and focused on clinical trials, technical advances in life saving equipment, and molecular mechanisms of pathology. Of particular interest were the results and implications of the PROWESS SHOCK study; a randomized controlled trial (RCT) to test the efficacy of Xigris, which had been used licensed to treat sepsis for the past ten years. The trial showed that it had no improvement in outcome, and it was subsequently withdrawn from the market due to lack of efficacy. Prof Derek Angus gave an excellent commentary on the results of this study and its potential implications, including interpretation of clinical trial results, and future therapies for sepsis. Jean-Louis Vincent, who also chaired the conference, provided some reassurance from the negative results with Xigris, with results from a global phase 2b on thromobomodulin, which is another potential therapy for sepsis.

Exciting developments in the field of ventilation in the ICU were also discussed and debated. For example, acute respiratory distress syndrome (ARDS) is a life threatening condition that requires the patient to be immobilized and put on a ventilator for breathing support to oxygenate the blood. However, ventilator induced lung injury (VILI) is a common problem. A relatively novel and increasingly used technique which has been developed to avoid this problem, is the method of extracorporeal membrane oxygenation (ECMO) , and the pros and cons of this were discussed by Ville Pettila and Antonio Pesenti.

Interestingly, this work has implications for ICU recovery in terms of mobilization and length of stay in hospital. Muscle wasting is an important complication to consider, and Eddy Fan discussed how use of techniques such as ECMO, which allows the patient to be mobile, can drastically minimize this. Nick Hart also gave an interesting talk on the molecular mechanisms behind muscle wasting in the ICU with a view to finding additional targets for therapy.

It is hoped that the topics discussed at this conference, which encompassed many aspects of advances in science and technology, will lead to novel insights and a deeper understanding of issues and challenges in this field.

Posted by Lin Lee at 14:21    Comments (0)

New developments in bipolar disorders

Bipolar disorder (BD) formerly known as manic-depressive illness is a mood disorder that is characterized by severe swings of elated behaviour termed mania and deep depression. The etiology of the disorder show a large genetic component with recent studies suggesting gene-environment interactions are important. The World Health Organization (WHO) indicate that bipolar disorder is the 6th leading cause of disability in the world and thus significant research funding has been invested at the National Institute of Mental Health in the USA, to understand its cause, treatment and underlying molecular mechanisms.

Several findings from funded research were recently presented at the 5th Biennial Conference of the International Society for Bipolar Disorders, which took place on 14th to 17th March 2012 in the beautiful surroundings of Istanbul, the Turkish city built on seven hills. The interesting program consisted of 4 keynote lectures, 6 core symposia and 16 parallel symposia which attracted more than 900 participants including psychiatrists and clinical researchers. The opening keynote lectures focussed on an evocative debate on pediatric bipolar disorder, which highlighted the disabling disorder in children and adolescents and the need for a well defined diagnosis. 

The first core symposium on optimizing functional outcomes in bipolar disorder commenced with a fascinating presentation by Prof Michael Berk on lifestyle factors such as diet, exercise and smoking that contribute to mood disorders. Other highlights of the meeting included a symposium devoted to the development and determinants of psychopathology in prospective bipolar offspring cohorts. The hot topic of personalized medicine in psychiatry was discussed by Prof Charles Nemeroff on prediction of disease vulnerability and treatment response in bipolar disorders; whereas the session on biomarkers in mood disorders emphasized integrative analyses across molecular, imaging and clinical domains. The molecular basis of bipolar disorder was addressed by Prof Tadafumi Kato who presented research from his group on mitochondrial dysfunction in bipolar disorder, where they observed differences in DNA methylation status in postmortem brains, and neuron specific accumulation of mitochondrial DNA mutations in a mouse model of bipolar disorder.          

In a timely fashion, a core symposium was dedicated to the update of criteria of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) that will be published in May 2013. With the launch of our cross-journal thematic series on "Towards a new psychiatry", new submissions on this important topic are being considered. Treatment response to mood stabilizers was addressed throughout the meeting with Prof John Kelsoe showing new data of an association between elated mania with and a single nucleotide polymorphism in neurotrophic tyrosine kinase, receptor, type 2 (NTKR2) in bipolar patients that responded positively to lithium. Further breaking news highlighted the deoxynucleotidyltransferase terminal, interacting protein 2 (DNTTIP2), a gene involved in the expression of the oestrogen receptor. Differential DNA methylation levels of this gene were observed in blood samples from monozygotic twins discordant for bipolar disorder, which was replicated in post-mortem brain samples from bipolar disorder patients and additionally significantly associated with total brain volume.

This exciting meeting generated novel clues that will help to further delineate the basis and functional molecular consequences of bipolar disorder and its treatment. The great opportunities to meet key opinion leaders in psychiatry at the conference resulted in welcoming Profs Charles Nemeroff, Michael Berk, John Kelsoe, Martin Preisig and Michael Bauer as editorial board members to BMC Medicine. We look forward to stimulating collaborations and future international meetings.

Posted by Ursula D'Souza at 10:41    Comments (0)

Multi-domain cognitive training improves mental functioning in the elderly

Posted by Claire Tree-Booker at 13:42    Comments (0)

New treatment strategies for lung cancer

Lung cancer is the second most common type of cancer in the UK, with 38,000 people being diagnosed each year. Biological therapies that target the epidermal growth factor (EGF) receptor are used to treat lung cancer in a subset of patients with EGF receptor mutations. These EGF receptor inhibitors, including afatinib, cetuximab, gefitinib and erlotinib, are associated with improved progression-free survival compared with chemotherapy. However, ultimately the tumours develop resistance, which often occurs due to further mutations in the EGF receptor.

In a new study published by BMC Medicine, Jacques De Grève and colleagues explore new strategies to overcome the problem of drug resistance, and show that interference with the EGF receptor gene using siRNA causes death of lung cancer cells. siRNA works by binding to a specific gene sequence in order to switch it off, preventing protein expression. The authors showed that siRNA was able to prevent lung cancer cell growth and cause death even in cells with resistance mutations in the EGF receptor. Importantly, siRNA enhanced the effects of afatinib, cetuximab, gefitinib and erlotinib, both in cells with and without resistance mutations. The strongest inhibition of cell growth was seen with a combination of siRNA and afatinib. 

The study unveils a potential new therapeutic approach to tackle drug-resistant lung cancer. Recent research has shown that siRNA therapy can be given to people and can prevent expression of specific genes, highlighting that a combination of EGF receptor inhibitors and siRNA is a feasible future therapy. The cell-based study by De Grève and colleagues reveals the exciting possibility of a drug-siRNA combination approach against lung cancer; future studies should extend these important findings into people and could confirm their therapeutic potential for drug-resistant lung cancer.

Posted by Claire Tree-Booker at 10:44    Comments (0)

Controversial Neurology : debates on diagnosis, pathology and treatment options at CONy 2012

Neurological conditions encompass a wide spectrum of disorders such as dementia, degenerative diseases, neuromuscular disease, epilepsy and migraine. Treatment  options for many neurological conditions can prove to be complex due to high variability between patients of the same disease. Additionally, diagnosis of many conditions, such as migraine  is still a topic of much debate, and as such, there is much interest within these fields of research. Ongoing debates amongst neurologists on these topics were discussed in Vienna (March 8th – 11th ) at the  6th annual Controversies in Neurology conference (CONy), chaired by the BMC Medicine editorial board member, Prof Amos D. Korcyzn of Tel Avi University, Israel. The conference encourages these differences in opinion to be openly discussed, with sessions designed to include both a ‘pro’ and ‘contra’ argument on a given topic.

Amongst the highlights of CONy 2012 was a particularly lively debate between Michel Ferrari and Messoud Ashina on whether or not Familial Hemiplegic Migraine (FHM), is a useful genetic model for common migraine despite the fact that common migraine is genetically heterogeneous. The controversial topic on the use of valproate for treatment of epilepsy in women of childbearing age was also vigorously debated between Alla Guekht and Gerhard Luef, since high doses, although well tolerated and efficacious against seizures, can cause congenital malformation.

Marinos C. Dalakas and Abhijit Chaudhuri discussed the main reasons behind the clinicians decision to use plasma exchange or IVIg in the treatment of various neuroimmune disorders;  while in the debate on dementia, the importance of amyloid vs tau pathology was debated at great length between Ezio Giacobini and Johannes Thome. The argument over whether research on the role of amyloids in Alzheimer's disease (AD) has provided any useful targets for therapy seemed to divide the audience, as some felt that tau is a more promising target in AD therapy, and therefore more efforts into research should be focused in that area. In addition, the current developments and future uses  of  reliable prognostic and predictive biomarkers in AD was discussed between Peter Riederer and Panteleimon Giannakopoulos.

All sessions provided  an exciting forum for debate, with audience participation being very much encouraged. These controversies can shape the way in which research should be directed, and it is hoped that this conference will spark new ideas and collaborative efforts in this diverse, divisive and progressive field.

Posted by Lin Lee at 11:57    Comments (0)

Genetic defects in the embryo could lead to early pregnancy loss

Early pregnancy loss (EPL), or miscarriage, occurs in around one in four pregnancies. The most common causes of EPL are genetic, including embryonic chromosome abnormalities and DNA mutations in the sperm or egg. Other causes include maternal hormonal disorders such as polycystic ovary syndrome, infections and anatomical abnormalities affecting the mother’s reproductive system. EPL that occurs in the first trimester of pregnancy is usually due to embryonic problems, whereas EPL in the second trimester is more commonly caused by health conditions in the mother. It is estimated that embryonic chromosome abnormalities are responsible for approximately two thirds of first trimester miscarriages.

Despite its high prevalence, the molecular mechanisms underlying EPL have not been fully characterized. DNA methylation, a process that alters gene expression in cells, is known to be important for embryonic development; aberrant DNA methylation caused by inactivation of enzymes responsible for the process, called DNA methyltransferases (DNMTs), has been associated with birth malformations.

In a new study published in BMC Medicine, He-Feng Huang and colleagues showed that levels of DNA methylation in the chorionic villi between mother and embryo were significantly lower in women with EPL, compared with unaffected pregnancies. However, there was no change in the level of DNA methylation in the lining of the uterus. These findings suggest that aberrant DNA methylation in the embryo, but not in the mother, could be responsible for EPL.

The authors explored these findings further in a mouse model, and showed that disrupting DNA methylation using a DNMT inhibitor leads to abnormal embryonic development. Importantly, DNMT inhibition also reduced embryonic attachment to cells of the uterus. Together, the data demonstrate that defects in DNA methylation in the embryo are associated with abnormal development and could give rise to EPL.

The study shows for the first time that aberrant DNA methylation in the embryo rather than the mother could be involved in EPL, uncovering a potential new target for monitoring women at risk of EPL. Following this important finding, further investigations to fully characterize the mechanisms responsible in the embryo could validate DNA methylation as a target to monitor the risk of EPL, and could improve our understanding of the genes involved.

Posted by Claire Tree-Booker at 10:46    Comments (0)

Low carbs and toxic sugars – New speakers for our Metabolism, Diet and Disease conference

Does fructose contribute to metabolic disease? Luc Tappy from the University of Lausanne will join a distinguished list of speakers to talk about whether his studies supports the controversial hypothesis that sugar is toxic at the first BioMed Central conference on Metabolism, Diet and Disease in Washington DC on May 29-31 2012.

Looking at the flipside of the same vexed question, Jeff Volek from the University of Connecticut and Nutrition & Metabolism journal will present evidence of the effects of low-carbohydrate diets on metabolic syndrome.

In a world where the incidence of cancer, obesity, diabetes and related health problems are rapidly on the rise, Metabolism, Diet and Disease is a very timely event that is bringing together top-class scientists from various fields to examine the issues.

The committee and speakers are world leaders in their fields. Craig B. Thompson, President of Memorial Sloan-Kettering Cancer Center (MSKCC), heads the committee which also includes Michael S. Brown and Joseph L. Goldstein, who received the Nobel Prize for Physiology or Medicine in 1985 for their discoveries concerning the regulation of cholesterol metabolism. Speakers include Bruce Spiegelman, Harvard Medical School, who will divulge the latest on the hormone irisin and how it replicates the benefits of exercise, and Jeffrey Friedman, who was the joint recipient of the 2010 Albert Lasker Basic Medical Research Award for discoveries that led to the identification of leptin, the hormone that regulates appetite and body weight.

Speakers and discussants will consider how the latest research into these metabolic problems can integrate with nutritional and epidemiological knowledge to address the challenge of obesity to public health. The meeting will cover topics ranging from insulin resistance and fat metabolism through to ageing and new strategies for drug therapies.

Obesity is an important determinant of cancer risk. In addition to the scientific talks, a panel discussion will focus on the connection between cancer and obesity that has come to light in recent years and what we can do about it – both by understanding the link and by tackling obesity with scientifically informed strategies.

Take advantage of the early-bird registration rates that are currently available and secure your place at what promises to be a key event in the metabolism and nutrition calendar. For early bird rates, register and submit an abstract by 21 March 2012.

 Penny Webb, Scientific Editor - Conferences

Posted by Alice Plane at 17:47    Comments (0)

Muscle wasting disease improved by Fasudil

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Low back pain: rest versus exercise therapy

Low back pain is a short-lived common disorder but this chronic condition can last for up to 12 months in some patients. Although current clinical guidelines recommend exercise therapy, this is not usually encouraged for patients suffering from low back pain who also show pathological alterations to the bone and spine (Modic changes). It has been hypothesized that a beneficial treatment for this patient group would need to incorporate adequate rest to allow the bone to heal.

Therefore to test this hypothesis, a randomized controlled clinical trial published in BMC Medicine, conducted by Prof Manniche and colleagues, compared rest and exercise therapies in 100 patients with chronic nonspecific low back pain and a high occurrence of Modic changes, at 10 weeks post-treatment and at a one-year follow-up. The study carried out at the Spine Center of Southern Denmark revealed patients who exercised once a week but continued their routine activity to have similar small improvements in pain, disability and general health to patients who had two hours daily rest and the choice of lumbar belt usage. 

The findings suggest patients with chronic low back pain and Modic changes can incorporate normal physical activity in their lifestyles. Further research will aid in identifying specific patient subgroups that would successfully respond to different treatments.

Posted by Ursula D'Souza at 14:06    Comments (0)

Orthopaedics and Sports Medicine specialists convene in London ahead of the 2012 Olympic Games

BMC Medicine attended the 7th national conference of Orthopedics and Sports Medicine in London on the 14th-15th February. This was a meeting that was especially timely given the forthcoming Olympic Games in London this year. The 50 specialists attending included orthopedic surgeons, physiotherapists, radiologists, and psychologists. Moreover, interest in this area of medicine was such that there were a substantial number of attendees of various disciplines who attended purely due to a personal interest in sports and sports medicine.

This field of medicine encompasses a large variety of disciplines, which was reflected in the wide range of topics the speakers presented. A common theme throughout the presentations was the issue of rehabilitation, both based in physiology and in psychology.

Lieutenant Colonel Jon Houghton gave an excellent presentation on what we can learn from the military in terms of sports injury rehabilitation. In another aspect of rehabilitation, platelet rich plasma (PRP) therapy, which aims to provide faster healing for muscle and tendon injuries but controversial in terms of outcome, was discussed in a thought-provoking presentation by Prof Nicola Maffulli.

Dr Richard Budgett, who is the Chief Medical Officer at the British Olympic Association and has his own Olympic gold medal in rowing, discussed performance enhancing drugs with a view of what to expect in the London 2012 Olympics. In a very different but no less interesting talk, Ms. Britt Tajet-Foxell, a psychologist working at the Royal Ballet Company in London, discussed how working through psychological barriers can lead to Olympic success.

This conference highlighted recent advances in sports and orthopaedic medicine. With the forthcoming London Olympics, and the focus of exercise as a disease modifying and health beneficial regime, progression in this field of medicine continues to be hotly anticipated.

Posted by Lin Lee at 13:36    Comments (0)