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18-02-2013 | Article

Global medical news in review: February 11–17, 2013

medwireNews: A roundup of select stories of interest to US physicians from the MerckMedicus Medical News wire.

Stimulating deterrent

Migraines are a common ailment that burdens the healthcare system a hefty $ 20 billion per year in the USA, according to the International Association for the Study of Pain.

In the past 20 years, neuromodulatory approaches that were initially used to treat intractable pain have additionally been used to target primary headaches with the advantage of being nondestructive while often being minimally invasive and adjustable.

To explore the efficacy of one such form of neurostimulation, a Belgian study in Neurology conducted trigeminal neurostimulation using a supraorbital transcutaneous stimulator, showing the device to be as effective as other drug and nondrug antimigraine treatments in safely preventing migraines.

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Pertinent overlap

The relationship between borderline personality disorder (BPD) and bipolar disorder (BD) has been unclear to date, as numerous assessments have reached differing - if not opposing - conclusions on the matter; from suggesting that BD is part of the bipolar spectrum to viewing there being no link at all.

A large multinational study in Acta Psychiatrica Scandinavica assessed the prevalence of bipolarity in a sizeable sample of adult patients with major depressive episodes (MDE) and, indeed, found a high occurrence of BD in individuals with co-existing BPD and depression.

The finding, say the authors, suggests that clinicians should keep an eye out for bipolarity in patients with MDE and prominent borderline characteristics and consider respective pharmacologic and psychological treatment options.

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Traumatic scenarios

When healthcare providers in emergency departments and inpatient wards focus on treating a patient, their first consideration is not the environment where care is being given.

Yet a study in JAMA Internal Medicine finds that the often chaotic and stressful hospital scenes faced by patients can be distressful to a lasting degree.

By looking at small sample of patients with acute coronary syndrome at a single, overly crowded emergency department, authors found that there is actually a significant increase in the likelihood of developing post-traumatic stress disorder. The finding calls for more innovative designs for future emergency departments and ward rooms that minimize exposure to jarring hospital environments.

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Drug of choice

Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, represent one of the most ubiquitously used drugs ever as they are used to treat common conditions such as headaches, toothaches, backache, and arthritis.

But along with these benefits come a few adverse side effects that affect the stomach (indigestion and stomach ulcers) as well as increasing the risk for heart attacks and stroke. Therefore, people at high risk for cardiovascular diseases should abstain from using NSAIDs.

To specify which NSAIDs are more associated with a certain level of cardiovascular risk than others, a PLoS Medicine study used national Essential Medicines Lists to look at how the respective evidence has been translated into guidance and sales in 15 low-, middle-, and high-income countries.

Overall, higher risk NSAIDs are widely used across all countries with diclofenac being the most popular drug despite carrying an increased relative risk for cardiovascular events.

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Preamble wheeze

Over the past few decades it has been established that the lung is a target organ for diabetes and the systemic inflammatory disorder that comes with it. In general, lungs of people with Type 2 diabetes deteriorate more quickly than normal.

While Type 2 diabetes and metabolic syndrome have been tied to impaired lung function, it is still not known whether the long prelude to Type 2 diabetes, or prediabetes, also has a damaging pulmonary impact.

In a Diabetes Research and Clinical Practice study to see whether such an association exists, Japanese researchers conducted a cross-sectional study, which showed that impaired fasting glucose is linked to low forced vital capacity, which is an indicator for restrictive lung disease. An association with obstructive lung disease was not found.

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By Peter Sergo, medwireNews Reporter