Wednesday, 10 February 2016

Coconut oil stops tooth decay by blocking Streptococcus mutans bacteria

Study: Coconut oil stops tooth decay and Candida albicans by blocking Streptococcus mutans bacteria

Something my mom does that is kind of cool: She puts coconut oil on the ends of her hair. When you shampoo your hair, you’re trying to get the oil out of your roots, but you really want the rest of your hair to maintain its moisture. When you put coconut oil on the ends, the shampoo gets oil out of the roots, but also protects the ends
Blake Lively, American actress, model and celebrity homemaker, in Magazine the Cut
Researchers at the Athlone Institute of Technology (AIT) in Ireland have discovered that coconut oil effectively prevents the growth of harmful oral bacteria. By calling a halt to these harmful oral bacteria, mouth infections, dental cavities and also Candida albicans have little chance.
The researchers actually wanted to mimic the human digestion of various types of vegetable oils by enzymes. They then exposed these oils that had been digested by enzymes to all kinds of bacteria. And thus also to Streptococcus mutans which often occurs in the mouth. Streptococcus mutans is a bacterium that produces acids which result in tooth decay. By interacting with Candida albicans, Streptococcus mutans can also cause fungal infections (Candida albicans).
The AIT researchers found that several bacteria had no chance with coconut oil. Coconut oil did not give bacterial growth and its consequential acid and fungus formation a chance. Coconut oil was the only oil in the study that could do this. Dr. D. Brady, one of the researchers, concluded moreover that on the one hand, coconut oil can give your immune system an enormous boost. And that on the other hand, coconut oil can thwart pathogens that cause illness (micro-organisms) in the mouth, intestines and elsewhere.
Coconut oil stops tooth decay and Candida albicans by blocking Streptococcus mutans bacteria
Coconut oil is amply contained in Amanprana mouth oil (Mint and Fennel). In Amanprana mouth oil, coconut oil is enhanced with antiseptic essential oils of herbs. A study in the Netherlands proved the antiseptic action of Amanprana mouth oil against lactic acid bacteria. Amanprana mouth oil is 0% chemicals and 100% natural, 100% organic and 100% active.

Opinion of Amanprana: fluoride versus coconut oil!!

If we compare coconut oil with fluoride in connection with dental quality, we see that coconut oil is the winner by far. According to my research, it has never been adequately proven scientifically that fluoride actually prevents tooth decay. What has been sufficiently demonstrated is that fluoride can be harmful to teeth (dental fluorosis) and general health. Dental fluorosis is identified by yellow and/or brown spots on the teeth. A sign of weakening of the teeth and bones. Too much fluoride makes your bones weaker and causes more fractures. Shane Ellison, author, chemist and founder of '', suggests that fluoride also attacks collagen. Collagen is a protein that provides for the elasticity of the skin and ensures flexible joints and ligaments.
Even the World Health Organisation (WHO) states that there may be health disadvantages associated with fluoride. The Assistant Secretary for Health Dr. H Koh (USA) is opposed to the fluoridation of water and food. (Source: Medical 11.3.2011) In my opinion, fluoride in drinking water, toothpaste, infant formulas, baby foods, beverages, medicines should be restricted.
Bart Maes, founder of Amanprana

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Cervical Myelopathy

Cervical Myelopathy

Topic updated on 01/28/16 5:06pm
  • A clinical syndrome caused by compression on the spinal cord that is characterized by
    • clumsiness in hands
    • gait imbalance 
  • Pathophysiology
    • etiology
      • degenerative cervical spondylosis (CSM) topic
        • most common cause of cervical myelopathy
        • compression usually caused by anterior degenerative changes (osteophytes, discosteophyte complex) 
        • degenerative spondylolisthesis and hypertrophy of ligamentum flavum may contribute
      • congenital stenosis
        • symptoms usually begin when congenital narrowing combined with spondylotic degenerative changes in older patients
      • OPLL 
      • tumor
      • epidural abscess 
      • trauma
      • cervical kyphosis
    • neurologic injury
      • mechanism of injury can be
        • direct cord compression
        • ischemic injury secondary to compression of anterior spinal artery
  • Associated conditions
    • lumbar spinal stenosis  
      • tandem stenosis occurs in lumbar and cervical spine in ~20% of patients
  • Prognosis
    • natural history
      • tends to be slowly progressive and rarely improves with nonoperative modalities
      • progression characterized by steplike deterioration with periods of stable symptoms
    • prognosis
      • early recognition and treatment prior to spinal cord damage is critical for good clinical outcomes
Classification of Myelopathy
Nurick Classification
Grade 0Root symptoms only or normal
Grade 1Signs of cord compression; normal gait
Grade 2Gait difficulties but fully employed
Grade 3Gait difficulties prevent employment, walks unassisted
Grade 4Unable to walk without assistance
Grade 5Wheelchair or bedbound
Based on gait and ambulatory function 
Ranawat Classification
Class IPain, no neurologic deficit
Class IISubjective weakness, hyperreflexia, dyssthesias
Class IIIAObjective weakness, long tract signs, ambulatory
Class IIIBObjective weakness, long tract signs, non-ambulatory
Japanese Orthopaedic Association Classification
  • A point scoring system (17 total) based on function in the following categories 
    • upper extremity motor function
    • lower extremity motor function
    • sensory function
    • bladder function
Presentation of Myelopathy
  • Symptoms 
    • neck pain and stiffness
      • axial neck pain (often times absent)
      • occipital headache common
    • extremity paresthesias
      • diffuse nondermatomal numbness and tingling
    • weakness and clumsiness
      • weakness and decreased manual dexterity (dropping object, difficulty manipulating fine objects)   
    • gait instability  
      • patient feels "unstable" on feet
      • weakness walking up and down stairs
      • gait changes are most important clinical predictor
    • urinary retention
      • rare and only appear late in disease progression
      • not very useful in diagnosis due to high prevalence of urinary conditions in this patient population
  • Physical exam
    • motor 
      • weakness
        • usually difficult to detect on physical exam
        • lower extremity weakness is a more concerning finding
      • finger escape sign
        • when patient holds fingers extended and adducted, the small finger spontaneously abducts due to weakness of intrinsic muscle
      • grip and release test
        • normally a patient can make a fist and release 20 times in 10 seconds. myelopathic patients may struggle to do this
    • sensory 
      • proprioception dysfunction
        • due to dorsal column involvement 
        • occurs in advanced disease
        • associated with a poor prognosis
      • decreased pain sensation
        • pinprick testing should be done to look for global decrease in sensation or dermatomal changes
        • due to involvement of lateral spinothalamic tract 
      • vibratory changes are usually only found in severe case of long-standing myelopathy
    • upper motor neuron signs (spasticity) 
      • hyperreflexia
        • may be absent when there is concomitant peripheral nerve disease (cervical or lumbar nerve root compression, spinal stenosis, diabetes)
      • inverted radial reflex
        • tapping distal brachioradialis tendon produces ipsilateral finger flexion
      • Hoffmann's sign  
        • snapping patients distal phalanx of middle finger leads to spontaneous flexion of other fingers
      • sustained clonus post
        • > three beats defined as sustained clonus
        • sustained clonus has poor sensitivity (~13%) but high specificity (~100%) for cervical myelopathy
      • Babinski test post
        • considered positive with extension of great toe
    • gait and balance
      • toe-to-heel walk
        • patient has difficulty performing
      • Romberg test 
        • patient stands with arms held forward and eyes closed
        • loss of balance consistent with posterior column dysfunction
    • provocative tests
      • Lhermitte Sign 
        • test is positive when extreme cervical flexion leads to electric shock-like sensations that radiate down the spine and into the extremities
  • Radiographs
    • recommended views
      • cervical AP, lateral, oblique, flexion, and extension views
    • general findings
      • degenerative changes of uncovertebral and facet joints
      • osteophyte formation
      • disc space narrowing
      • decreased sagittal diameter
        • cord compression occurs with canal diameter is < 13mm
    • lateral radiograph
      • important to look for diameter of spinal canal
        • a Pavlov ratio of less than 0.8 suggest a congenitally narrow spinal canal predisposing to stenosis and cord compression
      • sagittal alignment
        • C2 to C7 alignment  
          • determined by tangential lines on the posterior edge of the C2 and C7 body on lateral radiographs in neutral position
        • local kyphosis angle  
          • the angle between the lines drawn at the posterior margin of most cranial and caudal vertebral bodies forming the maximum local kyphosis
    • oblique radiograph
      • important to look for foraminal stenosis which often caused by uncovertebral joint arthrosis
    • flexion and extension views
      • important to look for angular or translational instability
      • look for compensatory subluxation above or below the spondylotic/stiff segment
    • sensitivity/specificity
      • changes often do not correlate with symptoms
        • 70% of patients by 70 yrs of age will have degenerative changes seen on plain xrays
  • MRI
    • indications
      • MRI is study of choice to evaluate degree of spinal cord and nerve root compression 
    • findings
      • effacement of CSF indicates functional stenosis
      • spinal cord signal changes 
        • seen as bright signal on T2 images (myelomalacia)  
        • signal changes on T1-weighted images correlate with a poorer prognosis following surgical decompression
      • compression ratio of < 0.4 carries poor prognosis 
        • CR = smallest AP diameter of cord / largest transverse diameter of cord
    • sensitivity/specificity
      • has high rate of false positive (28% greater than 40 will have findings of HNP or foraminal stenosis)
  • CT without contrast
    • can provide complementary information with an MRI, and is more useful to evaluate OPLL and osteophytes
  • CT myelography
    • more invasive than an MRI but gives excellent information regarding degrees of spinal cord compression
    • useful in patients that cannot have an MRI (pacemaker), or have artifact (local hardware)
    • contrast given via C1-C2 puncture and allowed to diffuse caudally, or given via a lumbar puncture and allowed to diffuse proximally by putting patient in trendelenburg position.
  • Nerve conduction studies
    • high false negative rate
    • may be useful to distinguish peripheral from central process (ALS)
  • Normal aging
    • mild symptoms of myelopathy often confused with a "normal aging" process
  • Stroke
  • Movement disorders
  • Vitamin B12 deficiency
  • Amyotrophic lateral sclerosis (ALS) 
  • Multiple sclerosis
  • Nonoperative
    • observation, NSAIDs, therapy, and lifestyle modifications
      • indications
        • mild disease with no functional impairment
          • function is a more important determinant for surgery than physical exam finding 
        • patients who are poor candidates for surgery
      • modalities
        • medications (NSAIDS, gabapentin)
        • immobilization (hard collar in slight flexion)
        • physical therapy for neck strengthening, balance, and gait training
        • traction and chiropractic modalities are not likely to benefit and do have some risks
        • be sure to watch patients carefully for progression
      • outcomes
        • improved nonoperative outcomes associated with patients with larger transverse area of the spinal cord (>70mm2) 
        • some studies have shown improvement with immobilization in patients with very mild symptoms
  • Operative 
    • surgical decompression, restoration of lordosis, stabilization 
      • indications
        • significant functional impairment AND
        • 1-2 level disease
        • lordotic, neutral or kyphotic alignment
      • techniques
        • appropriate procedure depends on
          • cervical alignment
          • number of stenotic levels
          • location of compression
          • medical conditions (e.g., goiter)
        • treatment procedures include (see below)
          • anterior cervical diskectomy/corpectomy and fusion
          • posterior laminectomy and fusion 
          • posterior laminoplasty
          • combined anterior and posterior procedure 
          • cervical disk arthroplasty 
      • outcomes
        • prospective studies show improvement in overall pain, function, and neurologic symptoms with operative treatment
        • early recognition and treatment prior to spinal cord damage is critical for good clinical outcomes
  • Goals
    • optimal surgical treatment depends on the individual. Things to consider include 
      • number of stenotic levels
      • sagittal alignment of the spine
      • degree of existing motion and desire to maintain
      • medical comorbidities (eg, dysphasia)
        • simplified treatment algorithm  
  • Anterior Decompression and Fusion (ACDF) alone
    • indications
      • mainstay of treatment in most patients with single or two level disease 
      • fixed cervical kyphosis of > 10 degrees  
        • anterior procedure can correct kyphosis
      • compression arising from 2 or fewer disc segments 
      • pathology is anterior (OPLL, soft discs, disc osteophyte complexes)
    • approach 
      • uses Smith-Robinson anterior approach  
    • decompression
      • corpectomy and strut graft may be required for multilevel spondylosis
        • two level corpectomies tend to be biomechanically vulnerable (preferable to combine single level corpectomy with adjacent level diskectomy)
        • 7% to 20% rates of graft dislodgement with cervical corpectomy with associated severe complications, including death, reported.
    • fixation
      • anterior plating functions to increase fusion rates and preserve position of interbody cage or strut graft
    • pros & cons
      • advantages compared to posterior approach
        • lower infection rate
        • less blood loss
        • less postoperative pain
      • disadvantages 
        • avoid in patients with poor swallowing function
  • Laminectomy with posterior fusion 
    • indications
      • multilevel compression with kyphosis of < 10 degrees
        • > 13 degrees of fixed kyphosis is a contraindication for a posterior procedure  
      • in flexible kyphotic spine, posterior decompression and fusion may be indicated if kyphotic deformity can be corrected prior to instrumentation
    • contraindications
      • fixed kyphosis of > 10 degrees is a contraindication to posterior decompression
      •  will not adequately decompress spinal cord as it is "bowstringing" anterior  
    • pros & cons
      • fusion may improve neck pain associated with degenerative facets
      • not effective in patients with > 10 degrees fixed kyphosis
  • Laminoplasty 
    • indications
        • gaining in popularity
        • useful when maintaining motion is desired
        • avoids complications of fusion so may be indicated in patients at high risk of pseudoarthrosis
      • contraindications  
        • cervical kyphosis 
          • > 13 degrees is a contraindication to posterior decompression  
          •   will not adequately decompress spinal cord as it is "bowstringing" anterior
        • severe axial neck pain
          • is a relative contraindication and these patients should be fused
      • technique
        • volume of canal is expanded by hinged-door laminoplasty followed by fusion  
          • usually performed from C3 to C7
        • open door technique
          • hinge created unilateral at junction of lateral mass and lamina and opening on opposite side
          • opening held open by bone, suture anchors, or special plates
        • French door technique
          • hinge created bilaterally and opening created midline
      • pros & cons
        • advantages
          • allows for decompression of multilevel stenotic myelopathy without compromising stability and motion (avoids postlaminectomy kyphosis)
          • lower complication rate than multilevel anterior decompression
            • especially in patients with OPLL
          • a motion-preserving technique
            • pseudoarthrosis not a concern in patients with poor healing potential (diabetes, chronic steroid users)
          • can be combined with a subsequent anterior procedure
        • disadvantage
          • higher avergae blood loss than anterior procedures 
          • postoperative neck pain
          • still associated with loss of motion
        • outcomes
          • equivalent to multilevel anterior decompression and fusion 
      • Combined anterior and posterior surgery
        • indications
          • multilevel stenosis in the rigid kyphotic spine
          • multi-level anterior cervical corpectomies 
          • postlaminectomy kyphosis
      • Laminectomy alone 
        • indications
          • rarely indicated due to risk of post laminectomy kyphosis   
        • pros & cons
          • progressive kyphosis
            • 11 to 47% incidence if laminectomy performed alone without fusion
      • Surgical Infection
        • higher rate of surgical infection with posterior approach than anterior approach
      • Pseudoarthrosis
        • incidence
          • 12% for single level fusions, 30% for multilevel fusions
        • treatment
          • treat with either posterior wiring or plating or repeat anterior decompression and plating if patient has symptoms of radiculopathy
      • Postoperative C5 palsy 
        • incidence   
          • reported to occur in ~ 4.6% of patients after surgery for cervical compression myelopathy 
          • no significant differences between patients undergoing anterior decompression and fusion and posterior laminoplasty
          • occurs immediately postop to weeks following surgery
        • mechanism
          • mechanism is controversial
          • in laminectomy patients, it is thought to be caused by tethering of nerve root with dorsal migration of spinal cord following removal of posterior elements
        • prognosis
          • patients with postoperative C5 palsy generally have a good prognosis for functional recovery, but recovery takes time
      • Recurrent laryngeal nerve injury
        • approach
          • in the past it has been postulated that the RLN is more vulnerable to injury on the right due to a more aberrant pathway
            • recent studies have shown there is not an increased injury rate with a right sided approach
        • treatment
          • if you have a postoperative RLN palsy, watch over time
          • if not improved over 6 weeks than ENT consult to scope patient and inject teflon
          • if you are performing revision anterior cervical surgery, and there is an any suspicion of a RLN from the first operation, obtain ENT consult to establish prior injury
            • if patient has prior RLN nerve perform revision surgery on the same as the prior injury/approach to prevent a bilateral RLN injury
      • Hardware failure and migration
        • 7-20% with two level anterior corpectomies
        • two level corpectomies should be stabilized from behind
      • Postlaminectomy kyphosis
        • treat with anterior/posterior procedure 
      • Postoperative axial neck pain
      • Vertebral artery injury
      • Esophageal Injury
      • Dysphagia & alteration in speech