New analysis of trial has shown that urgent aggressive intervention has shown to reduce the risk for a recurrent stroke in patients with TIA or a minor stroke.
The Early Use of Existing Preventive Strategies for Stroke or EXPRESS trial results have confirmed that quick assessment and response to events such as TIA and minor strokes could reduce the 90-day risk for recurrent stroke by 80%.
http://www.medscape.com/viewarticle/564188
Obesity during adolescence may carry the same risk of premature death as smoking at least 10 cigarettes a day during adulthood according to a study publish in the British Medical Journal. Even overweight carries risk comparable to less heavy smoking.
The study defined overweight and obesity according to BMI, which was considered as one of the limitations of the study. Overweight was defined as BMI between 25 and 29.9 kg/m2, and obesity as BMI of 30 kg/m2 or more.
Obesity is slowly becoming a cause of concern in all but the poorest regions in the world. Co-morbid conditions in obesity include hypertension, increased blood cholesterol, arthritis, and diabetes.
The study concluded that overweight and obesity in late adolescence increases risk of adult mortality regardless of smoking status, though smoking may have a synergistic effect with overweight or obesity.
The Advisory Committee on Immunization Practices (ACIP) has issued a guideline for the prevention of rotavirus infection.
Rotavirus gastroenteritis is the most common cause of severe gastroenteritis in infants and children worldwide.
The virus causes approximately 500,000 deaths per year in children below 5 years old, and 80% of these are from the developing countries.
ACIP recommends the use of two vaccines: RV1 (GlaxoSmithKline Biologicals) and RV5 (Merck and Company). The committee does not express preference for either. Both vaccines are administered orally.
The administration schedule for RV1 is a two dose series administered at 2 and 4 months. RV5 is a three dose series administered at 2, 4 and 6 months.
Some of the changes made from the 2006 ACIP guidelines are:
More changes and recommendations, such as use with other vaccines, can be found at this Medscape article.
From the American Academy of Pain Medicine 25th Annual Meeting, one report from a pain expert has revealed the complexity of the management of pain in the elderly and one study discusses how perception of pain affects interleukin-6 levels.
Debra Weiner, MD said during the annual meeting that even though degenerative processes may be normal during aging, pain is not. Specialists should be part of a multi-disciplinary team when it comes to managing chronic pain in older individuals.
She remarked that self-rated health is a predictor of morbidity and mortality. Since pain is associated with poor self-rated health, it can be argued that chronic pain may predict mortality.
Dr. Weiner also noted that another challenge lies in managing chronic pain in patients with dementia, especially in patients with undiagnosed dementia.
On another note, a study revealed that patients who focused on their pain, felt helpless when experiencing it and pessimistic about the outcome had increased levels of IL-6. This finding was used to take into consideration the effects of negative emotions on pain-related catastrophizing.
Pain-related catastrophizing consists of negative cognitive and emotional processes, including the magnification of pain-related symptoms and rumination about pain.
The study found that individuals who were higher catastrophizers had higher levels of the proinflammatory cytokine IL-6. Feelings of helplessness, pessimism, and rumination in some people may trigger inflammatory responses which can increase pain sensitivity.
A University of Pennsylvania study has linked excessive television exposure in teens to an increased risk for depression in adulthood.
It was shown that every hour of excess television use, an equivalent of 8% increase in the odds of developing depressive symptoms during young adulthood.
Depression has bee cited by the World Health Organization as the leading cause of morbidity worldwide and is very common in adolescents.
The study have shown that young women are less likely to develop depressive symptoms as young men.
Results were they same among different media types; television, video cassettes, computer games, and radio. The study was made before internet use became widespread and DVDs were popular.
Other studies have shown a link between excessive use of certain media, social anxiety and decline in interpersonal relationships. Obesity, substance use and aggression has also been linked to large amounts of media exposure.
The Canadian Hypertension Education Program (CHEP) has warned against combining angiotensin II receptor blocker (ARB) drugs with ACE inhibitors medications. The combination known as dual renin-angiotensin system (RAS) blockade was shown to cause poor renal outcomes.
The Renal Outcomes With Telmisartan, Ramipril, or Both, in People at High Vascular Risk (ONTARGET) study has shown that telmisartan, an ARB, is noninferior to the ACE inhibitor ramipril. But combining the two together causes more adverse outcomes like increased risk for dialysis, doubling of serum creatinine and death.
It is up to the individual organizations to decide whether or not to issue warnings about this drug combination.
Results of a trial presented during the Society of Critical Care Medicine congress revealed that ICU patients who were awakened early and frequently had better cognitive function.
Patients in the ICU are often sedated because it was believed to cause less trauma to the patient of having undergo the experience of being in the intensive care unit.
The Awakening and Breathing Controlled (ABC) trial involved 187 ICU patients: 94 in the control group and , 93 who had attempts at stopping sedation and attempts at weaning off the ventilator.
Cognitive function, post-traumatic stress disorder (PTSD), and depression were assessed upon discharge and at 3 months and 12 months after discharge.
Incidence of PTSD was equal in both groups with only a few cases. Depression was again equal but with high incidence, 50% to 60% at 12 months for both groups.
ABC had improved cognitive function compared to control at all time points. Prolonged sedation is being associated impaired brain function. There is also a strong association between heavy sedation and increased risk to delirium. The presence of delirium sees a 2-fold increase of infection.
It seems that working long hours can drive you crazy.
Well, not exactly crazy but it can cause mild cognitive impairment.
A prospective study conducted in the UK showed that middle-aged participants, having a mean age of 52.1 years, who worked 55 hours per week fared worse in cognitive function tests as compared to counterparts working 35 to 40 hours per week.
The cognitive tests included test on short-term verbal memory, verbal and mathematical reasoning, vocubulary, phonemtic fluency and semantic fluency.
The study suggests that aside from biological age and disease, work-related factors such as working overtime might play into cognitive decline.
Working long hours has also been associated with cardiovascular disease, diabetes, fatigue and depression.
A published study in Neurology showed that individuals who are socially active and not easily stressed are less likely to develop mental deterioration later in life.
Individuals who were described to have low neuroticism and high extroversion are 50% less likely to develop dementia as compared to people who were prone to distress and less socially active.
Clinicians are encouraged to tell their older patients to be more “sociable, active, optimistic, and calm.”
Another study has linked diabetes to a distinct separate pattern of cerebral damage in dementia.
Patients who had dementia and diabetes showed more microvascular infarcts and more inflammation of the neural tissue as compared to those who had dementia but no diabetes.
The cerebral damage pattern in dementia without diabetes is described as having greater beta-amyloid peptide load and free-radical damage.
More evidence show that NSAIDs, not just COX-2 inhibitors, have been shown to in a new study to be harmful to heart failure patients.
The study published in the Annals of Internal Medicine said that patients taking COX-2 inhibitors, as well as other NSAIDs, had an increase risk of death or rehospitalization due to heart failure or myocardial infarction.
Even naproxen, which was shown to be the ‘best’ among the NSAIDs, still causes fluid retention which was detrimental to heart failure patients.
