Emerging Diagnostics and Therapeutics for Non-alcoholic Fatty Liver Disease

The obesity epidemic has pushed fatty liver disease, which consists of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis, to the forefront of the 21st century. Disease identification can be done invasively with a liver biopsy or noninvasively through elastography and measurements of biomarkers, such as the alanine aminotransferase (ALT) and aspartate aminotransferase (AST) liver enzymes. Presently, there are no FDA-approved drugs on the market to treat the disease. Alternative medicinal treatments have been investigated, which include altering the intestinal microbiota and consuming anti-inflammatory, herbal-based, vitamin-based, and plant-based medications, in addition to following a healthy lifestyle. In this study, multiple databases were used to identify articles pertaining to fatty liver disease (FLD). Databases included Biomedical Reference Collection: Comprehensive, Cumulative Index of Nursing and Allied Health (CINAHL), Google Scholar, and PubMed. All articles gathered from the databases were peer-reviewed and less than 10 years old to ensure the credibility of the work and recent information regarding the disease. A total of 13 articles were used to gather information for this review. All articles were confirmed to be peer-reviewed by checking them with Ulrich's web. In all 13 peer-reviewed articles, the diagnosis of FLD was most commonly done by analyzing ALT and AST liver enzymes and lipid profiles. Liver ultrasound, liver FibroScan, and liver biopsy served as other tools used for detecting the presence of FLD. It was observed that anti-inflammatory, herbal-based, vitamin-based, and plant-based medications and healthy gut microbiota had beneficial and therapeutic effects in treating FLD when coupled with healthy lifestyle changes. All medicinal treatments were found to lower the ALT and AST liver enzymes, lipid profiles (total cholesterol, triglycerides, low-density lipoprotein), and liver steatosis scores in studies where ultrasound was used before and after treatment. Further investigation is needed to fully understand the mechanisms behind the therapeutic effects of treating FLD; however, the medicinal treatments discussed in this review show promising prospects for treating the disease. The therapeutic effects of anti-inflammatory, herbal-based, vitamin-based, and plant-based medications and living a healthy lifestyle were seen in lower levels of liver enzymes, improved lipid profiles, and lower steatosis scores, with no reported side effects on subjects. The treatment options studied may have beneficial impacts in treating FLD patients and may be used in the development of future medications to combat the disease.

Non-steroidal Anti-inflammatory Drugs and Osteopathic Manipulative Treatment for Pain Management in Patients With Osteoarthritis: A Literature Review

The pathophysiology of osteoarthritis (OA) involves the destruction of articular cartilage and the overgrowth of bone with lipping and spur formation. Nerve endings in the joint capsule and adjacent tissues play a major role in the pain mechanisms of osteoarthritis. This often requires patients to seek pain control measures beyond over-the-counter drugs, such as local anesthetics. Osteopathic manipulation treatment (OMT) is a conservative, non-pharmacological treatment that can be used to help treat chronic pain associated with OA. Other non-pharmacologic therapies include weight loss, exercise, physical therapy (PT), and assistive devices. However, pharmacologic management may be added synergistically to control flares and maintain baseline activities of daily living. While oral non-steroidal anti-inflammatory drugs (NSAIDs) have been the mainstay of treatment for pain and inflammation associated with OA, they have a non-selective inhibitory action that often results in negative side effects when used chronically. The possibility of minimizing these complications through alternate treatments such as topical NSAIDs provides an opportunity for patients to receive adequate pain relief from OA without suffering unnecessary consequences. This literature review seeks to assess the state of research regarding topical NSAIDs and OMT as alternatives to the current gold-standard treatment of OA. The significant inclusion criteria consisted of articles that described the effects of OMT on OA or the use of topical NSAIDs such as Voltaren on OA. Due to the limited articles found, a qualitative analysis was performed, and the salient conclusions are outlined. Alternative pharmacological and non-pharmacological treatments, such as topical diclofenac gel and OMT, have shown promising results in the treatment of pain in OA. It is seen that a majority of patients achieve pain management using NSAIDs, acetaminophen, or topical analgesics. Both diclofenac sodium and OMT have individually been shown to be effective treatments of OA when compared to the use of oral NSAIDs. A holistic treatment approach that utilizes both topical diclofenac sodium and OMT may provide OA patients with an effective option to reduce their moderate to severe chronic pain with limited side effects. Further, high-quality randomized controlled trials are needed to identify whether synergistic effects occur when combining diclofenac sodium gel and OMT for pain relief in patients with OA.