Breaking the wave: Transition to Recovery
19 Aug 2022
Peripheral neuropathy: Past, Present and Future
In his lecture, Prof. Rayaz Malik strongly advocated for a stronger focus on peripheral neuropathy. The full impact of peripheral neuropathy – which Dr. Malik calls the Cinderella complication – remains underappreciated, as physicians will rarely test for it early when it is more preventable. Prof. Malik highlighted the use of the 5-step approach to aid in the evaluation of patients with neuropathic symptoms. He also shared studies on the use of corneal confocal microscopy (CCM) showing high sensitivity and specificity in the definitive diagnosis of peripheral neuropathy that are clinically comparable to the gold standard: skin biopsy.
Prof. Malik stressed that there is evidence that COVID-19 exacerbates peripheral neuropathy. In cases of long COVID, corneal nerve fiber loss and increased dendritic cells were identified on CCM according to Dr. Malik. Studies show that patients continue to experience neuropathic symptoms up to roughly 4 months after initial COVID-19 infection.
Management of Peripheral Neuropathy with Neurotropic B Vitamins
Dr. Arabinda Mukherjee discussed updates on the widely practiced therapeutic regimen of B vitamins in peripheral neuropathy. Early use of high doses of the neurotropic B vitamins – particularly B1, B6, and B12 – has been shown to provide better treatment outcomes.
With studies showing that nerve regeneration is only possible if less than 50% of the tissue is damaged, Dr. Mukherjee emphasized timely and adequate intervention before this point of no return. He also advised that early cessation of B vitamin therapy may lead to symptom relapse. He also cited studies revealing a significant reduction of disability in all etiological subgroups with high doses of B vitamins and a progressive reduction of symptoms over time. These favor long-term treatment and the wider use of B vitamins.
Case: Diabetes & Peripheral Neuropathy
Touching on points from both Prof. Malik and Dr. Mukherjee, Dr. Aimee Andag-Silva presented a case study of a diabetic patient with peripheral neuropathy. She emphasized the 5-step approach to the diagnosis of peripheral neuropathy and highlighted the utility of the Michigan Neuropathy Screening Instrument (MNSI). The MNSI is standardized against the US San Antonio consensus criteria and validated by electromyography and nerve conduction velocity studies among Filipinos. B vitamins were again demonstrated to be effective as an adjuvant in the treatment of neuropathic pain.
After the lecture, Dr. Andag-Silva and Dr. Mukherjee had a discussion about peripheral neuropathy and B vitamins. Dr. Mukherjee pointed out that there have been cases of peripheral neuropathy following both COVID-19 infection and COVID-19 vaccination. He said initial data suggest that peripheral neuropathy post-COVID vaccination is autoimmune-mediated. The mechanism of peripheral neuropathy in post-COVID infection remains unclear. High-dose B vitamins were recommended in both cases.
Understanding Iron and Immunity During Pregnancy - Updates on Iron Deficiency Anemia
Iron deficiency in pregnancy affects both maternal and fetal well-being and usually stems from lack of intake and markedly increased iron requirements during pregnancy. From the myriad of dire consequences of iron deficiency anemia, Dr. Maria Carmen Hernandez-Quevedo zeroed in on its detrimental effect on immunity, especially in pregnant women. Iron deficiency compromises immune response by impairing the innate immune cell activity and adaptive immune response across all age groups in the general population, including pregnant women. Studies show that pregnant mothers are more vulnerable to some infections and have a higher risk of severe disease in the presence of iron deficiency.
Dr. Hernandez-Quevedo emphasized that iron demand in pregnancy cannot be met by dietary intake alone. Thankfully, studies show that supplementation with an iron preparation is sufficient to address the requirements of pregnant women. Oral iron preparations – especially the ferrous fumarate formulation – can provide the necessary amount of elemental iron in pregnancy.
Making the Common Cold Less Common
Widely accepted myths and fallacies about the common cold are as common as the illness itself. In his lecture, Dr. Antonio Chua tackled these myths and fallacies with current scientific evidence. Following a review of the etiopathogenesis of the common cold, he emphasized the use of low pH mucoadhesive intranasal spray during the “opportunity to act” window. Evidence shows that interventions during this period – from exposure to onset of symptoms – significantly improve the incidence, duration, and severity of cold symptoms.
In a review of evidence on the widespread use of immune boosters against the common cold, studies revealed that ascorbic acid or vitamin C is more effective as a supplement than as a therapeutic dose. Dr. Chua however, cautioned in using high dose vitamin C, especially in individuals with kidney disease. Reviews have found that, zinc is better for symptomatic treatment in its gluconate form and that while vitamin D affords modest protection, it is better than none.
Sleep Deprivation Epidemic in Asia: How melatonin can Help People Sleep Naturally
In the last decade, sleep deprivation has come to the fore as a major health concern. In his lecture, Dr. Keith Aguilera reiterated that poor sleep has both immediate and long-term consequences, both physically and mentally. Among the undesirable effects of poor sleep include the interruption of the immune response, including the response to vaccination.
Dr. Aguilera emphasized the pivotal role of melatonin in coordinating the natural sleep process. Being an endogenous hormone, melatonin is a safe sleep supplement that helps decrease sleep latency and improve sleep duration. While melatonin is present in some food, it is practically impossible to get an effective amount from food sources alone. Supplemental melatonin, available in lower doses of 1-2mg is effective at improving sleep and is well tolerated.
Conclusion
Current scientific evidence supports the use of supplemental vitamins and minerals in boosting immunity and helping in healing and recovery. As we transition to the post pandemic health recovery, immune boosters and increasing awareness to early intervention can play a key role in improving patient outcomes and health behaviors.
In his lecture, Prof. Rayaz Malik strongly advocated for a stronger focus on peripheral neuropathy. The full impact of peripheral neuropathy – which Dr. Malik calls the Cinderella complication – remains underappreciated, as physicians will rarely test for it early when it is more preventable. Prof. Malik highlighted the use of the 5-step approach to aid in the evaluation of patients with neuropathic symptoms. He also shared studies on the use of corneal confocal microscopy (CCM) showing high sensitivity and specificity in the definitive diagnosis of peripheral neuropathy that are clinically comparable to the gold standard: skin biopsy.
Prof. Malik stressed that there is evidence that COVID-19 exacerbates peripheral neuropathy. In cases of long COVID, corneal nerve fiber loss and increased dendritic cells were identified on CCM according to Dr. Malik. Studies show that patients continue to experience neuropathic symptoms up to roughly 4 months after initial COVID-19 infection.
Management of Peripheral Neuropathy with Neurotropic B Vitamins
Dr. Arabinda Mukherjee discussed updates on the widely practiced therapeutic regimen of B vitamins in peripheral neuropathy. Early use of high doses of the neurotropic B vitamins – particularly B1, B6, and B12 – has been shown to provide better treatment outcomes.
With studies showing that nerve regeneration is only possible if less than 50% of the tissue is damaged, Dr. Mukherjee emphasized timely and adequate intervention before this point of no return. He also advised that early cessation of B vitamin therapy may lead to symptom relapse. He also cited studies revealing a significant reduction of disability in all etiological subgroups with high doses of B vitamins and a progressive reduction of symptoms over time. These favor long-term treatment and the wider use of B vitamins.
Case: Diabetes & Peripheral Neuropathy
Touching on points from both Prof. Malik and Dr. Mukherjee, Dr. Aimee Andag-Silva presented a case study of a diabetic patient with peripheral neuropathy. She emphasized the 5-step approach to the diagnosis of peripheral neuropathy and highlighted the utility of the Michigan Neuropathy Screening Instrument (MNSI). The MNSI is standardized against the US San Antonio consensus criteria and validated by electromyography and nerve conduction velocity studies among Filipinos. B vitamins were again demonstrated to be effective as an adjuvant in the treatment of neuropathic pain.
After the lecture, Dr. Andag-Silva and Dr. Mukherjee had a discussion about peripheral neuropathy and B vitamins. Dr. Mukherjee pointed out that there have been cases of peripheral neuropathy following both COVID-19 infection and COVID-19 vaccination. He said initial data suggest that peripheral neuropathy post-COVID vaccination is autoimmune-mediated. The mechanism of peripheral neuropathy in post-COVID infection remains unclear. High-dose B vitamins were recommended in both cases.
Understanding Iron and Immunity During Pregnancy - Updates on Iron Deficiency Anemia
Iron deficiency in pregnancy affects both maternal and fetal well-being and usually stems from lack of intake and markedly increased iron requirements during pregnancy. From the myriad of dire consequences of iron deficiency anemia, Dr. Maria Carmen Hernandez-Quevedo zeroed in on its detrimental effect on immunity, especially in pregnant women. Iron deficiency compromises immune response by impairing the innate immune cell activity and adaptive immune response across all age groups in the general population, including pregnant women. Studies show that pregnant mothers are more vulnerable to some infections and have a higher risk of severe disease in the presence of iron deficiency.
Dr. Hernandez-Quevedo emphasized that iron demand in pregnancy cannot be met by dietary intake alone. Thankfully, studies show that supplementation with an iron preparation is sufficient to address the requirements of pregnant women. Oral iron preparations – especially the ferrous fumarate formulation – can provide the necessary amount of elemental iron in pregnancy.
Making the Common Cold Less Common
Widely accepted myths and fallacies about the common cold are as common as the illness itself. In his lecture, Dr. Antonio Chua tackled these myths and fallacies with current scientific evidence. Following a review of the etiopathogenesis of the common cold, he emphasized the use of low pH mucoadhesive intranasal spray during the “opportunity to act” window. Evidence shows that interventions during this period – from exposure to onset of symptoms – significantly improve the incidence, duration, and severity of cold symptoms.
In a review of evidence on the widespread use of immune boosters against the common cold, studies revealed that ascorbic acid or vitamin C is more effective as a supplement than as a therapeutic dose. Dr. Chua however, cautioned in using high dose vitamin C, especially in individuals with kidney disease. Reviews have found that, zinc is better for symptomatic treatment in its gluconate form and that while vitamin D affords modest protection, it is better than none.
Sleep Deprivation Epidemic in Asia: How melatonin can Help People Sleep Naturally
In the last decade, sleep deprivation has come to the fore as a major health concern. In his lecture, Dr. Keith Aguilera reiterated that poor sleep has both immediate and long-term consequences, both physically and mentally. Among the undesirable effects of poor sleep include the interruption of the immune response, including the response to vaccination.
Dr. Aguilera emphasized the pivotal role of melatonin in coordinating the natural sleep process. Being an endogenous hormone, melatonin is a safe sleep supplement that helps decrease sleep latency and improve sleep duration. While melatonin is present in some food, it is practically impossible to get an effective amount from food sources alone. Supplemental melatonin, available in lower doses of 1-2mg is effective at improving sleep and is well tolerated.
Conclusion
Current scientific evidence supports the use of supplemental vitamins and minerals in boosting immunity and helping in healing and recovery. As we transition to the post pandemic health recovery, immune boosters and increasing awareness to early intervention can play a key role in improving patient outcomes and health behaviors.