Unusual worm-like radiopacities in the radiographs of patients with cervical spondylosis.

This report describes three patients with cervical spondylosis whose diagnostic radiographs showed worm-like, irregularly curved radiopaque lines and strings in the head and neck region during routine chiropractic examinations. Such artifacts are frequently misinterpreted as parasitic infection, electrostatic discharges, detector image lag, fracture, or ligature wires. All three patients with worm-like radiopacities disclosed their 15-20 years of history of acupuncture treatment to relieve neck pain. The present cases of unexpected and coincidental findings may suggest a possible acupuncture-caused radiographic artifacts in the neck and jaw bones. In particular, the patient had previous gold thread treatments possibly associated with the observed radiographic artifacts. These cases may emphasize the importance of having a thorough understanding of patient history regarding unexpected radiographic artifacts.

Screening and Diagnosing Osteoporosis Among Postmenopausal Women in Primary Care Settings in Malaysia: A Systematic Review.

Background: As the population of Malaysia is aging, osteoporosis is becoming more common, prompting the development of various clinical practice guidelines for screening and diagnosing in primary care settings. Given the lack of a systematic assessment of recommendations, we aimed to determine the extent between the guidelines and actuarial screening and diagnosing among postmenopausal women in Malaysia. Methods:The present research is a systematic review following the Cochrane Handbook for Systematic Reviews and the preferred reporting items for systematic reviews and meta-analyses (PRISMA) for clinical practice guidelines on the screening and diagnosing of osteoporosis in primary care settings (updated January 1, 2022). For this purpose, several databases were searched, including MEDLINE, EMBASE and CINAHL. Medical subject headings search terms were related to diagnosis and treatment of osteoporosis, clinical practice guidelines, primary settings and postmenopausal women. Two authors assessed records following consensus and evidence-based processes and reviewed the quality of identified studies using the Joanna Briggs Institute Critical Appraisal tools. Results:Six cross-sectional studies were included in our review. All of them showed a fair level of osteoporosis screening among postmenopausal women in Malaysia primary care settings. Included studies reported that 50% of participants had been diagnosed as osteopenia or osteoporosis. Advancing age, increase of menopause years, low bone mass index, low calcium intake, low education level and low income are positive indicators for osteoporosis. The diagnosis of osteoporosis is influenced by the accessibility of primary care providers on osteoporosis care and knowledge of osteoporosis among postmenopausal women. Conclusions:This systematic review has confirmed that there was a fair screening status in Malaysia. A renewed effort in primary care is needed to reduce the explicit gap in practice and meet the osteoporosis guideline. However, further reviews are needed to best inform future practice, specifically examine the challenges of primary care providers in osteoporosis management.

Chiropractic care of Parkinson's disease and deformity.

Parkinson's disease (PD) is a progressive neurological disease characterized by muscle stiffness, tremor, slowness of movement, and difficulties with posture and walking. Muscle and joint pain are frequent non-motor symptoms of PD. Pain associated with PD is mainly caused by a combination of truncal dystonia, stooped posture, and muscle rigidity. However, PD deformities were rarely discussed in the literature. A 68-year-old Asian female with PD treated with Levodopa for six years complained of progressive neck pain, contractures, and subluxation of both hands in the last two years. A positron emission tomography (PET) scan revealed decreased rostrocaudal gradient uptake in both posterior putamen. After 9 months of multimodal chiropractic rehabilitation, the patient had significant improvement in symptoms, including pain resolution as per the numeric rating scale and physical and mental improvement as per the PD questionnaire. Radiographic measurement showed significantly improved postural alignment and stability. Measurement of joint motion and angles showed an improvement in hand deformity. Although PD is a neurodegenerative disease that is not curable, multimodal rehabilitation may improve neurological and musculoskeletal functions by inducing proprioceptive balance, motor strength, and joint movement. The current study may illustrate multimodal rehabilitation addressing orthopedic deformity associated with symptoms in a PD patient.