Joyce Anastasi

Abstract

Gluten-free diets are increasing in popularity among consumers and fueling a global market of gluten-free products. A gluten-free diet is the only treatment for celiac disease (CD). However, many patients are self-reporting and suspecting "gluten sensitivity" after gastrointestinal symptoms, such as bloating, abdominal pain, or diarrhea, resolve on a gluten-free diet without formal evaluation testing for food allergies or CD. The terms related to gluten and/or wheat intolerance, nonceliac gluten sensitivity or wheat sensitivity, CD, and wheat allergy can be confusing. These forms of intolerance combined affect approximately 10% of the United States population. In this article we clarify the range of gluten and/or wheat disorders, clinical features, diagnosis, and management.

Abstract

Background: One of the principal diagnostic methods in Traditional Chinese Medicine (TCM) is the inspection of the tongue. This method involves examination of the shape, size, color, and texture of the tongue body and coat and helps reveal the state of organ functions and progression of conditions. Literature on tongue observations for patients who have human immunodeficiency virus (HIV) is minimal. Objective: The goal of this study was to provide a clinical "snapshot" of initial tongue assessments of 159 patients living with HIV, who participated in an acupuncture clinical trial for chronic nausea. The aim was to explore the similarities and differences observed in tongue assessments. Design: This study was part of a prospective, randomized, controlled, double-blinded (subjects and evaluators), parallel-groups, acupuncture clinical trial for treating chronic nausea. Setting: The study was conducted at a large urban New York City academic health center. Patients: The patients in this study were 159 individuals who had HIV infections and who had histories of chronic nausea for ≥3 months. Main Outcome Measures: Initial tongue assessments were recorded for seven basic characteristics: (1) tongue color; (2) tongue shape; (3) tongue body quality; (4) coat color; (5) coat weight; (6) coat surface; and (7) tongue action. Results: The overall tongue picture seen in these patients was that the tongue was swollen and toothmarked, had a pink body with cracks, and had a thick, dry white coat. Conclusions: The HIV disease itself and the use of long term medications affect the Blood, Qi, Yin, and Yang. The observation of the tongue provides a window into the process of the disease and, ultimately, insight for clinical care. This sample population snapshot illustrates the complex processes seen in long-term chronic conditions managed by pharmacologic medications.

Abstract

OVERVIEW: Despite the decline in the incidence of central nervous system disease associated with HIV, distal sensory peripheral (DSP) neuropathy continues to be prevalent in this population, causing debilitating symptoms and affecting quality of life. Patients typically present with numbness, tingling, burning pain, and loss of sensation in the toes and soles of their feet. Although this complication causes loss of protective function and puts patients at elevated risk for injury, infection, and falls, foot care for people with HIV is often overlooked. This article reviews what is known about DSP neuropathy in HIV and discusses relevant foot care guidelines, adopted from the literature on other conditions associated with neuropathic foot disorders.

Abstract

OVERVIEW: Irritable bowel syndrome (IBS), characterized by abdominal pain or discomfort associated with a change in bowel patterns, is one of the most common functional gastrointestinal disorders. Because no single drug effectively relieves all IBS symptoms, management relies on dietary and lifestyle modifications, as well as pharmacologic and nonpharmacologic therapies. The authors review current approaches to treatment and discuss nursing implications.

Abstract

This article draws from a study investigating the influence of institutional and psychosocial factors on adherence to antiretroviral (ARV) medications by Mexican-origin persons living with HIV (PWLH) on the U.S.-Mexico border and seeking treatment at a clinic in El Paso, Texas. Among 113 participants, many individuals reported using complementary and alternative medicines (CAM) to support general health and their immune systems and to address symptoms of HIV-related diseases and ARV side effects. CAM were seen as complementing ARV treatment; however, CAM use was often not reported to health care providers out of concern about disapproval and loss of care privileges. This finding challenges researchers and providers to consider seriously how Hispanic populations, with their CAM use, may exhibit the hybridization of health and healing. Information on CAM use needs to be available to providers to assess the benefits and contraindications of use and to develop realistic and effective care strategies.

Abstract

Irritable bowel syndrome (IBS), a chronic disorder, greatly impacts the lives of those affected. Approximately one quarter of the North American population suffers from this condition that includes abdominal pain, discomfort and alterations in normal bowel function. Constipation-subtype IBS (IBS-C) is often found to be a prevalent subtype; however, a lack of knowledge and effective treatment options remains surrounding this disorder. In the course of an ongoing study conducted by our research team on the use of acupuncture and moxibustion in the management of IBS symptoms, a considerable number of screened patients have met the widely accepted Rome III criteria for IBS-C.