Publications by authors named "Richard Nahas"

11 Publications

  • Page 1 of 1

Elevated and Slowed EEG Oscillations in Patients with Post-Concussive Syndrome and Chronic Pain Following a Motor Vehicle Collision.

Brain Sci 2021 Apr 24;11(5). Epub 2021 Apr 24.

The Seekers Centre, Ottawa, ON K1Z 5Z9, Canada.

(1) Background: Mild traumatic brain injury produces significant changes in neurotransmission including brain oscillations. We investigated potential quantitative electroencephalography biomarkers in 57 patients with post-concussive syndrome and chronic pain following motor vehicle collision, and 54 healthy nearly age- and sex-matched controls. (2) Methods: Electroencephalography processing was completed in MATLAB, statistical modeling in SPSS, and machine learning modeling in Rapid Miner. Group differences were calculated using current-source density estimation, yielding whole-brain topographical distributions of absolute power, relative power and phase-locking functional connectivity. Groups were compared using independent sample Mann-Whitney U tests. Effect sizes and Pearson correlations were also computed. Machine learning analysis leveraged a post hoc supervised learning support vector non-probabilistic binary linear kernel classification to generate predictive models from the derived EEG signatures. (3) Results: Patients displayed significantly elevated and slowed power compared to controls: delta ( = 0.000000, = 0.6) and theta power ( < 0.0001, = 0.4), and relative delta power ( < 0.00001) and decreased relative alpha power ( < 0.001). Absolute delta and theta power together yielded the strongest machine learning classification accuracy (87.6%). Changes in absolute power were moderately correlated with duration and persistence of symptoms in the slow wave frequency spectrum (<15 Hz). (4) Conclusions: Distributed increases in slow wave oscillatory power are concurrent with post-concussive syndrome and chronic pain.
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http://dx.doi.org/10.3390/brainsci11050537DOI Listing
April 2021

The polytrauma clinical triad in patients with chronic pain after motor vehicle collision.

J Pain Res 2018 20;11:1927-1936. Epub 2018 Sep 20.

Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.

Background: The polytrauma clinical triad (PCT) is a complex disorder composed of three comorbid diagnoses of chronic pain, post-traumatic stress disorder (PTSD), and postconcussion syndrome (PCS). PCT has been documented in veterans returning from deployment, but this is the first report on PCT prevalence in nonmilitary personnel after a motor vehicle collision (MVC).

Methods: Data were drawn from routine intake assessments completed by 71 patients referred to a community-based clinic for chronic pain management. All patients completed the post-traumatic stress disorder checklist for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (PCL-5), and Rivermead Post-Concussion Symptoms Questionnaire (RPQ) during a standardized intake assessment. An additional modified RPQ score was derived to address previously reported symptom overlap between PCS and chronic pain.

Results: Standard and modified RPQ scores yielded PCS prevalence rates of 100% and 54.9% in our sample, respectively. Results suggest that a modified RPQ score, limited to visual and vestibular symptoms, may be more useful PCS screening criteria in patients with chronic pain. PTSD screening criteria on the PCL-5 were met by 85.9% of the patients. More than half of the patients referred for chronic pain after MVC met criteria for PCT (52.1%). Patients who met PCT criteria reported worse headache, overall pain, and sleep quality outcomes.

Conclusion: Among patients in our sample with chronic pain after MVC, more than half met criteria for PCT. A modified approach to RPQ scoring limited to visual and vestibular symptoms may be required to screen for PCS in these patients.
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http://dx.doi.org/10.2147/JPR.S165077DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6160266PMC
September 2018

Natural health products.

Can J Diabetes 2013 Apr 26;37 Suppl 1:S97-9. Epub 2013 Mar 26.

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http://dx.doi.org/10.1016/j.jcjd.2013.01.029DOI Listing
April 2013

The effect of an EDTA-based chelation regimen on patients with diabetes mellitus and prior myocardial infarction in the Trial to Assess Chelation Therapy (TACT).

Circ Cardiovasc Qual Outcomes 2014 Jan 19;7(1):15-24. Epub 2013 Nov 19.

Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, FL.

Background: The Trial to Assess Chelation Therapy (TACT) showed clinical benefit of an EDTA-based infusion regimen in patients aged ≥50 years with prior myocardial infarction. Diabetes mellitus before enrollment was a prespecified subgroup.

Methods And Results: Patients received 40 infusions of EDTA chelation or placebo. A total of 633 (37%) patients had diabetes mellitus (322 EDTA and 311 placebo). EDTA reduced the primary end point (death, reinfarction, stroke, coronary revascularization, or hospitalization for angina; 25% versus 38%; hazard ratio, 0.59; 95% confidence interval [CI], 0.44-0.79; P<0.001) over 5 years. The result remained significant after Bonferroni adjustment for multiple subgroups (99.4% CI, 0.39-0.88; adjusted P=0.002). All-cause mortality was reduced by EDTA chelation (10% versus 16%; hazard ratio, 0.57; 95% CI, 0.36-0.88; P=0.011), as was the secondary end point (cardiovascular death, reinfarction, or stroke; 11% versus 17%; hazard ratio, 0.60; 95% CI, 0.39-0.91; P=0.017). However, after adjusting for multiple subgroups, those results were no longer significant. The number needed to treat to reduce 1 primary end point over 5 years was 6.5 (95% CI, 4.4-12.7). There was no reduction in events in non-diabetes mellitus (n=1075; P=0.877), resulting in a treatment by diabetes mellitus interaction (P=0.004).

Conclusions: Post-myocardial infarction patients with diabetes mellitus aged ≥50 demonstrated a marked reduction in cardiovascular events with EDTA chelation. These findings support efforts to replicate these findings and define the mechanisms of benefit. However, they do not constitute sufficient evidence to indicate the routine use of chelation therapy for all post-myocardial infarction patients with diabetes mellitus.

Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00044213.
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http://dx.doi.org/10.1161/CIRCOUTCOMES.113.000663DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4111470PMC
January 2014

Complementary and alternative medicine for the treatment of major depressive disorder.

Can Fam Physician 2011 Jun;57(6):659-63

University of Ottawa, Seekers Centre for Integrative Medicine, 6 Deakin St, Ottawa, ON K2E 1B3.

Objective: To review the clinical evidence supporting complementary and alternative medicine interventions for treating major depressive disorder.

Quality Of Evidence: PubMed was searched from January 1966 to February 2010 using the term depressive disorder in combination with St John's wort, S-adenosylmethionine (SAM-e), exercise, acupuncture, omega-3 fatty acids, and folate. Only relevant human trials were selected.

Main Message: In a large meta-analysis, St John's wort was found to be equivalent to antidepressant drugs with fewer side effects. Exercise reduced depressive scores in 3 meta-analyses. Omega-3 fatty acids reduced depressive scores in a meta-analysis of 16 trials, but publication bias was identified. Oral SAM-e monotherapy reduced depressive scores in 4 of 5 small randomized controlled trials. Folate deficiency is associated with more severe and refractory depression, and supplementation reduced depressive scores in 2 of 3 randomized controlled trials. Acupuncture demonstrated limited efficacy in 1 meta-analysis and 5 other trials.

Conclusion: St John's wort and regular exercise appear effective in the treatment of depression. Acupuncture appears ineffective for depression, but it might offer other health benefits. Other promising therapies include SAM-e, omega-3 fatty acid, and folic acid supplementation in selected patients; further study is warranted.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114664PMC
June 2011

Irritable bowel syndrome: common integrative medicine perspectives.

Authors:
Richard Nahas

Chin J Integr Med 2011 Jun 10;17(6):410-3. Epub 2011 Jun 10.

Seekers Centre for Integrative Medicine, 942 Merivale Road, Ottawa, Ontario, K1Z 5Z9, Canada.

Previous reviews have highlighted complementary and alternative medicine therapies that are used to treat irritable bowel syndrome (IBS) based on published clinical trial data. Here the author describes and comments on a number of potentially relevant factors that have been commonly emphasized by practitioners who treat IBS and patients who have the disease. They include gluten and other food allergies, the candida syndrome and biofilm, interference fields and post-infectious IBS, as well as mind-body factors.
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http://dx.doi.org/10.1007/s11655-011-0759-2DOI Listing
June 2011

Complementary and alternative medicine for prevention and treatment of the common cold.

Can Fam Physician 2011 Jan;57(1):31-6

Seekers Centre for Integrative Medicine, Ottawa, ON.

Objective: To review the evidence supporting complementary and alternative medicine approaches to treatment and prevention of the common cold in adults.

Quality Of Evidence: MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews were searched from January 1966 to September 2009 combining the key words common cold or influenza with echinacea, garlic, ginseng, probiotics, vitamin C, and zinc. Clinical trials and prospective studies were included.

Main Message: For prevention, vitamin C demonstrated benefit in a large meta-analysis, with possibly increased benefit in patients subjected to cold stress. There is inconsistent evidence for Asian ginseng (Panax ginseng) and North American ginseng (Panax quinquefolius). Allicin was highly effective in 1 small trial. For treatment, Echinacea purpurea is the most consistently useful variety; it was effective in 5 of 6 trials. Zinc lozenges were effective in 5 of 9 trials, likely owing to dose and formulation issues. Overall, the evidence suggests no benefit from probiotics for prevention or treatment of the common cold.

Conclusion: Vitamin C can be recommended to Canadian patients for prevention of the common cold. There is moderate evidence supporting the use of Echinacea purpurea and zinc lozenges for treatment. Ginseng and allicin warrant further research.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3024156PMC
January 2011

Complementary and alternative medicine for the treatment of type 2 diabetes.

Can Fam Physician 2009 Jun;55(6):591-6

Department of Family Medicine at the University of Ottawa, Seekers Centre for Integrative Medicine, 6 Deakin St, Ottawa, ON K2E 1B3, Canada.

Objective: To review clinical evidence supporting complementary and alternative medicine interventions for improving glycemic control in type 2 diabetes mellitus.

Quality Of Evidence: MEDLINE and EMBASE were searched from January 1966 to August 2008 using the term type 2 diabetes in combination with each of the following terms for specific therapies selected by the authors: cinnamon, fenugreek, gymnema, green tea, fibre, momordica, chromium, and vanadium. Only human clinical trials were selected for review.

Main Message: Chromium reduced glycosylated hemoglobin (HbA(1c)) and fasting blood glucose (FBG) levels in a large meta-analysis. Gymnema sylvestre reduced HbA(1c) levels in 2 small open-label trials. Cinnamon improved FBG but its effects on HbA(1c) are unknown. Bitter melon had no effect in 2 small trials. Fibre had no consistent effect on HbA(1c) or FBG in 12 small trials. Green tea reduced FBG levels in 1 of 3 small trials. Fenugreek reduced FBG in 1 of 3 small trials. Vanadium reduced FBG in small, uncontrolled trials. There were no trials evaluating microvascular or macrovascular complications or other clinical end points.

Conclusion: Chromium, and possibly gymnema, appears to improve glycemic control. Fibre, green tea, and fenugreek have other benefits but there is little evidence that they substantially improve glycemic control. Further research on bitter melon and cinnamon is warranted. There is no complementary and alternative medicine research addressing microvascular or macrovascular clinical outcomes.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2694078PMC
June 2009

Complementary and alternative medicine for treatment of irritable bowel syndrome.

Can Fam Physician 2009 Feb;55(2):143-8

Department of Family and Community Medicine at University of Ottawa in Ontario.

Objective: To review the evidence supporting selected complementary and alternative medicine approaches used in the treatment of irritable bowel syndrome (IBS).

Quality Of Evidence: MEDLINE (from January 1966), EMBASE (from January 1980), and the Cochrane Database of Systematic Reviews were searched until March 2008, combining the terms irritable bowel syndrome or irritable colon with complementary therapies, alternative medicine, acupuncture, fiber, peppermint oil, herbal, traditional, yoga, massage, meditation, mind, relaxation, probiotic, hypnotherapy, psychotherapy, cognitive therapy, or behavior therapy. Results were screened to include only clinical trials, systematic reviews, and meta-analyses. Level I evidence was available for most interventions.

Main Message: Soluble fibre improves constipation and global IBS symptoms. Peppermint oil alleviates IBS symptoms, including abdominal pain. Probiotic trials show overall benefit for IBS but there is little evidence supporting the use of any specific strain. Hypnotherapy and cognitive-behavioural therapy are also effective therapeutic options for appropriate patients. Certain herbal formulas are supported by limited evidence, but safety is a potential concern. All interventions are supported by systematic reviews or meta-analyses.

Conclusion: Several complementary and alternative therapies can be recommended as part of an evidence-based approach to the treatment of IBS; these might provide patients with satisfactory relief and improve the therapeutic alliance.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2642499PMC
February 2009

Complementary and alternative medicine approaches to blood pressure reduction: An evidence-based review.

Authors:
Richard Nahas

Can Fam Physician 2008 Nov;54(11):1529-33

Seekers Centre for Integrative Medicine, 6 Deakin St, Ottawa, ON K2E 1B3.

ABSTRACTOBJECTIVETo review the evidence supporting complementary and alternative medicine approaches used in the treatment of hypertension.QUALITY OF EVIDENCEMEDLINE and EMBASE were searched from January 1966 to May 2008 combining the key words hypertension or blood pressure with acupuncture, chocolate, cocoa, coenzyme Q10, ubiquinone, melatonin, vitamin D, meditation, and stress reduction. Clinical trials, prospective studies, and relevant references were included.MAIN MESSAGEEvidence from systematic reviews supports the blood pressure-lowering effects of coenzyme Q10, polyphenol-rich dark chocolate, Qigong, slow breathing, and transcendental meditation. Vitamin D deficiency is associated with hypertension and cardiovascular risk; supplementation lowered blood pressure in 2 trials. Acupuncture reduced blood pressure in 3 trials; in 1 of these it was no better than an invasive placebo. Melatonin was effective in 2 small trials, but caution is warranted in patients taking pharmacotherapy.CONCLUSIONSeveral complementary and alternative medicine therapies can be considered as part of an evidence-based approach to the treatment of hypertension. The potential benefit of these interventions warrants further research using cardiovascular outcomes.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2592323PMC
November 2008

Not enough vitamin D coverage.

Authors:
Richard Nahas

Can Fam Physician 2007 Dec;53(12):2104-5

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2231539PMC
December 2007