Evidence-based vitamin supplements for age-related macular degeneration: an analysis of available products

CLINICAL RELEVANCE

A wide range of supplements are available for age-related macular degeneration (AMD); however, clinicians may not be aware of which supplements contain an evidence-based formula.

BACKGROUND

Vitamin and antioxidant supplementation has been shown to be effective in slowing the progression of AMD. The Age-Related Eye Disease Studies (AREDS) group reported an evidence-based formula in the AREDS 2 trials. Commercially available products carry varying degrees of resemblance to this formula.

METHODS

A review of commercially available supplements in pharmacies and websites across Australasia, the United States, the United Kingdom, and Canada was undertaken. Supplements containing all the ingredients of the AREDS 2 recipe were included. The dose, formulation, and cost of the supplements were reviewed.

RESULTS

Sixty-six products were reviewed. Forty-three products contained all the AREDS 2 ingredients and were therefore included for analysis. Twenty products contained all ingredients at 100% or more of the recommended dose, and 23 products contained some ingredients at a lower dose. The cost of the products varied from Australian dollar (AUD) $0.12 to AUD $6.72 per day. Seven (35%) products were available online only and 13 (65%) products were available both online and in pharmacies. Eight products were available in the United States pharmacies, five products were available in Canadian pharmacies, three products were available in the United Kingdom pharmacies, and one product was available in Australasian pharmacies.

CONCLUSIONS

Commercially available AMD supplements vary widely in price and resemblance to the AREDS 2 formulation. Clinician awareness of this information is important when counselling patients on which supplement is most suitable. The categorisation of products in Table 1 may assist with patient counselling of vitamin supplementation for AMD.

COVID-19 restrictions amidst cyclones and volcanoes: A rapid assessment of early impacts on livelihoods and food security in coastal communities in Vanuatu

Coastal communities in regions like the Pacific have been impacted by COVID-19 related public health measures that limit the movement of people, trade and access to resources. In disaster-prone countries, like Vanuatu, such measures add to existing pressures on coastal communities' adaptive capacity. To understand how coastal communities in Vanuatu were impacted in the immediate period after COVID-19 measures were placed, and how people responded to the changing circumstances, a rapid appraisal survey was carried out following a nationally declared state of emergency in March 2020. Results reveal changes in village population, loss of cash income, difficulties in accessing food and shifting pressures on particular resources and habitats. The findings provide insights into the ways local adaptive capacity to satisfy livelihood and food security needs differed among rural contexts. From this we argue that broad quantitative impact assessments are important in guiding strategic and longer term responses and adaptations, but that these are made more useful when complemented with qualitative insights on people and place in the short-term.

Lump in the throat - a case study

Jack, aged 66 years, presented to his general practitioner with a foreign body sensation in his throat and altered voice, which developed over 30 minutes. He was otherwise well, having no other new symptoms or recent alterations to medication. He had not eaten anything unusual. He had hypertension, type 2 diabetes, stable ischaemic heart disease, urolithiasis and benign prostatic hypertrophy. His regular medication was metformin, rosuvastatin, carvedilol, candesartan (last 5 years) and saxagliptin (last 6 months). He had no allergies but was intolerant of ramipril due to cough. There was no family history of note. On examination he had no itch or rash, or swelling of the tongue, lips, cheek or neck. However, there was oedema of the soft palate and uvula. He was maintaining his airway, saturating at 98%, and his chest was clear. He was afebrile and systemically well.

The impact of sport and active recreation injuries on physical activity levels at 12 months post-injury

The aim of this study was to evaluate the impact of serious sport and active recreation injury on 12-month physical activity levels. Adults admitted to hospital with sport and active recreation-related injuries, and captured by the Victorian Orthopaedic Trauma Outcomes Registry were recruited to the study. Changes between preinjury and 12 month post-injury physical activity was assessed using the short International Physical Activity Questionnaire (IPAQ). Independent demographic, injury, and hospital variables were assessed for associations with changes in physical activity levels, using multivariate linear regression. A total of 324 patients were recruited, of which 98% were followed up at 12 months. Mean short IPAQ scores decreased from 7650 METS (95% CI: 7180, 8120) preinjury to 3880 METS; (95% CI: 3530, 4250) post-injury, independent of functional recovery. Education level and occupation group were the only variables independently associated with changes in physical activity levels post-injury. These results highlighted that sport and active recreation injuries lead to significant reductions in physical activity levels. Hence, the prevention of sport and active recreation injuries is important when considering promotion of activity at a population level.

ACEI associated angioedema - a case study and review

BACKGROUND

Angioedema is an infrequent but potentially serious adverse effect of angiotensin converting enzyme inhibitors (ACEIs).

OBJECTIVE

This article describes a case of ACEI associated angioedema and reviews important clinical features of the condition.

DISCUSSION

The mechanism of ACEI associated angioedema is not allergic (histamine mediated), but rather due to an alteration of the balance of bradykinin and other vasodilator mediators. Onset may be delayed for weeks, months or years and episodes may be recurrent. Occasionally, airway obstruction may occur. Diagnosis is from history and physical examination; there is no specific diagnostic test. In contrast to allergic angioedema, ACEI associated angioedema is generally unresponsive to corticosteroids and antihistamines, although these agents are often used by convention. In the longer term, cessation of the ACEI is necessary to reduce the risk of recurrent episodes.

Evaluation of the role of platelet integrins in fibronectin-dependent spreading and adhesion

BACKGROUND

Recent studies have shown that platelet adhesion and subsequent aggregation can occur in vivo in the absence of the two principal platelets adhesive ligands, von Willebrand factor and fibrinogen. These results highlight a possible role for fibronectin in supporting thrombus formation.

OBJECTIVE AND METHODS

To evaluate the platelet integrins and subsequent activation pathways associated with fibronectin-dependent platelet adhesion utilizing both human and murine platelets.

RESULTS

Platelets can adhere to fibronectin via the integrin alpha(IIb)beta(3), leading to formation of lamellipodia. This is mediated through an interaction with the tenth type III domain in fibronectin. Spreading on fibronectin promotes alpha(IIb)beta(3)-mediated Ca(2+) mobilization and tyrosine phosphorylation of focal adhesion kinase and phospholipase C gamma2. In contrast, studies with blocking antibodies and mice demonstrate that alpha(5)beta(1) and alpha(v)beta(3) support adhesion and promote formation of filopodia but not lamellipodia or tyrosine phosphorylation of these proteins. Further, neither alpha(5)beta(1) nor alpha(v)beta(3) is able to induce formation of lamellipodia in the presence of platelets agonists, such as collagen-related-peptide (CRP).

CONCLUSIONS

These observations demonstrate that integrins alpha(5)beta(1) and alpha(v)beta(3) support platelet adhesion and the generation of filopodia but that, in contrast to the integrin alpha(IIb)beta(3), are unable to promote formation of lamellipodia.

Genetic and environmental influences in the development of multiple primary melanoma

OBJECTIVES

To identify risk factors and the prognosis associated with the development of multiple primary melanoma (MPM).

DESIGN

Case-comparison studies of subjects with MPM and single primary melanoma. Sequencing of CDKN2A in germline DNA.

SETTING

Population-based study of patients with invasive melanoma in Scotland between 1979 and 1996.

PATIENTS

For mortality studies, 108 patients with MPM and 216 single melanoma controls matched for age, sex, site, and tumor thickness. For risk factor studies, 48 patients with MPM and 48 single melanoma controls matched as above. For CDKN2A analysis, a sample of 23 subjects with MPM.

RESULTS

The development of MPM was found not to be an independent prognostic factor. The risk of MPM was greatest in those with a family history of melanoma, with large numbers of benign nevi, and the presence of clinically or histologically atypical nevi. Germline mutations of CDKN2A were present in 6 of 23 patients with MPM and in 5 cases consisted of the base pair substitution Met53Ile.

CONCLUSIONS

The importance of MPM should be addressed in melanoma follow-up protocols. Those patients at greatest risk can be identified by a family history of melanoma and their mole pattern. Germline mutations in CDKN2A occur in both familial and sporadic MPM and further studies are required to determine the value of analysis of this gene in melanoma surveillance. Patients should be informed that the development of MPM does not adversely affect their prognosis.

CDKN2A germline mutations in U.K. patients with familial melanoma and multiple primary melanomas

We report six of 16 U.K. melanoma families and two of 17 patients with multiple primary melanomas and a negative family history who have between them four different functionally damaging mutations of the CDKN2A (p16) gene: an Arg 24 Pro substitution in exon 1 in one family, a stop codon at codon 44 of exon 1 in one family, and a Met 53 Ile substitution in exon 2 in four families. One multiple primary melanoma patient also has the Met 53 Ile mutation and a second has a G-T substitution at the IVS2 + 1 splice donor site. Our data together with other recent publications from France and the U.S.A. indicate that screening melanoma kindreds with only two affected family members for CDKN2A mutations is justified.