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03-02-2013 | Article

Global medical news in review: January 27-February 3, 2013

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

Gauging the confused

Delirium is a mental disorder that regularly occurs in medical and surgical inpatients. This psychiatric manifestation of an underlying medical illness is known to cause a higher mortality rate, extend hospital stay, reduce functional recovery, and increase likelihood of being placed in a nursing home.

Rapid recognition and effective treatment of delirium is a must. Yet medical and surgical doctors often fail to detect delirium, often assigning it to other psychiatric illnesses such as depression or anxiety.

This lack of recognition was further confirmed by a BMJ Open study that found delirium is failing to receive proper consideration by hospital staff. Something as simple as briefly questioning the patient could make all the difference.

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Perimeter culprit

Barrett's esophagus - also known as Barrett syndrome or columnar epithelium lined lower esophagus - occurs when cells lining the inferior portion of the esophagus get damaged by stomach acid and change into cells that are similar to those that line the stomach.

Several studies have associated the disease with body mass index; a relationship that a current study in Gut not only failed to find but also disputes as being confounded by unmeasured abdominal obesity.

Instead, the researchers found waist circumference to be an independent predictor of risk for Barrett's esophagus.

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Efficacy deficiency

Choosing the appropriate agent to treat headaches in children and adolescents hinges on the patient's comorbid conditions and the effect profile of the medication. The pharmacological selection for headache treatment is either abortive - for acute headaches - or prophylactic - to reduce frequency or severity.

To better vet the plethora of treatment options, which range from antiepileptics to antihypertensive agents, a meta-analysis study in JAMA Pediatrics looked at the comparative effectiveness and adverse effects of a variety of drugs.

The assessment generally found drug efficacy to be limited or unsupported while showing the significant alleviation that placebos provide.

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Halted protocol

High frequency oscillation ventilation (HFOV) has been put forward as an ideal form of lung protection due to its physiologic rational, expanded use worldwide, and promising small randomized control trial results.

Yet a nascent multinational trial to compare the effect of early HFOV with lung-protective conventional ventilation on all-cause hospital mortality among patients with severe early acute respiratory distress syndrome (ARDs) ended prematurely due to evidently higher in-hospital mortality in the HFOV group.

Experts in The New England Journal of Medicine comment on the circumstances and warn about routine HFOV use in patients with ARDS.

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Arrhythmic threat

Most sudden cardiac deaths (SCD) are brought about by arrhythmias - the most common life-threatening one being ventricular fibrillation. Atrial fibrillation (AF) is also associated with increased risk for cardiac morbidity and mortality but it is not well understood whether AF is associated with increased risk for SCD.

Researchers sought to add clarity to this and found that people who develop AF have more than a two-fold chance of succumbing to SCD, as reported in JAMA Internal Medicine.

The association was found to only be partially explained by other risk factors while other experts cautioned about the clinical implications the association might have when managing AF or SCD.

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By Peter Sergo, medwireNews Reporter