Daily ReCAP April 12, 2017

Chronic: Silk Clothing Does Not Improve Eczema Severity in Children

Silk clothing is unlikely to provide additional clinical or economic benefits over standard care for children with moderate to severe eczema, a new study published inPLOS Medicinefound. The investigators recruited 300 children aged 1 to 15 years with moderate to severe eczema from 5 UK centers. The participants were randomized into 2 groups, with half receiving the standard of care and the other half receiving the standard of care plus silk garments that are claimed to be beneficial for eczema. The results of the study showed that after 6 months, there were no significant differences observed in eczema severity among the groups nor were there differences in quality of life or medication use. The authors added that the silk garments were unlikely to be cost effective, with a computed cost per quality adjusted life year of silk garments to be GBP 56,811. A limitation to the study was the use of an objective outcome measure, which may underestimate changes in symptoms.

Acute: Spinal Manipulative Therapy Demonstrates Modest Improvements in Low Back Pain

Spinal manipulative therapy was associated with modest improvements in pain and function among patients with acute low back pain, according to a study published inJAMA. The investigators sought to conduct a review and meta-analysis of 26 prior studies to assess the efficacy and harms associated with spinal manipulative therapy compared with other nonmanipulative therapies for adults with acute low back pain. Of the 26 eligible randomized clinical trials (RCTs) identified, 15 RCTs of 1711 patients showed moderate-quality evidence that spinal manipulative therapy had a significant association with improvement in pain. Twelve RCTs that included 1381 patients produced moderate-quality evidence that spinal manipulative therapy had a statistically significant association with improvements in function. None of the RCTs reported any serious adverse events (AEs,) and minor transient AEs such as increased pain, muscle stiffness, and headache were reported in more than half of patients in the large case series. The authors noted that the size of benefit of spinal manipulative therapy for acute low back pain is about the same as the benefit from nonsteroidal anti-inflammatory drugs. “Among patients with acute low back pain, spinal manipulative therapy was associated with modest improvements in pain and function and with transient minor musculoskeletal harms,” the authors concluded.

Preventive: Vitamin B Reverses Negative Effects of Pollution on the Cardiovascular System

Vitamin B supplements can reduce the impact of a common air pollutant on cardiovascular disease, according to a study published inScientific Reports. Ambient fine particulate pollution contributes to 3.7 million premature deaths worldwide per year, predominately through acute effects on the cardiovascular system. “Ambient PM2.5 pollution is one of the most common air pollutants and has a negative effect on cardiac function and the immune system,” said principal investigator Jia Zhong, PhD. “For the first time, our trial provides evidence that B-vitamin supplementation might attenuate the acute effects of PM2.5 on cardiac dysfunction and inflammatory markers.” Included in the study were 10 healthy nonsmokers ages 18 to 60 years who were not on any form of vitamin B supplements or other medication. All of the participants received a placebo for 4 weeks preceding a 2-hour exposure experiment to concentrated ambient PM2.5 (250 g/m3). The participants were then administered B vitamin supplements for 4 weeks before the next 2-hour exposure experiment to PM2.5. The results of the study showed that a 2-hour exposure to concentrated ambient PM2.5 had substantial physiologic impacts on heart rate, heart rate variability, and white blood counts. They also found that 4-week treatment with B vitamin supplements nearly reversed any negative effects on the participants cardiovascular and immune systems.