Global medical news in review: March 3–9, 2013
medwireNews: A roundup of select stories of interest to US physicians from the MerckMedicus Medical News wire.
Opening an airway
Obstructive sleep apnea (OSA) is a dangerous sleep condition that involves an occasional cessation of breathing during sleep that can lead to severe cardiovascular, neurologic, and metabolic disorders.
One of the risk factors underlying the development and progression of the condition is obesity, which is associated with respiratory disturbance as well as oropharyngeal tissue growth. To assess the effectiveness of, and compliance with, various ways to alleviate OSA, a European Archives of Otorhinolaryngology study found that obese patients with severe OSA had an unfavorable response but high compliance with continuous airway positive pressure.
While small in number compared to the millions of surgical procedures that occur each year, 550 to 650 fires happen in, on or around a patient who is undergoing a medical procedure. Some fires have caused second- and third-degree burns to patients and can be fatal if they occur in their airway.
According to a US review of surgical malpractice claims in Anesthesiology, most of the operating room fires are caused by electrocautery, the rate of which has increased from less than 1% of all surgical claims in 1985-1994 to 4.4% in 2000-2009.
The researchers underlined the importance of recognizing the dangers of supplemental oxygen by an open delivery system during electrocautery use in addition to other elements that create operating room fires.
Most adults with asthma fail to properly control their symptoms, despite effective drug treatment options. Medical guidelines advise corticosteroids (ICS) plus rapid-onset, long-acting β2 agonist (LABA) combination inhaler to achieve control, along with a second inhaler that has short-acting β2 for rescue usage.
Two studies in The Lancet Respiratory Medicine found that two asthma medications that are combined in a single inhaler is the best treatment to both rescue and prevent asthma in adults who suffer from asthma symptoms that are difficult to control.
The therapy, which is known as SMART (Single Inhaler Maintenance and Reliever Therapy), challenges American and International asthma guidelines by having the lone inhaler have only ICS and LABA.
Directly to the source
Nearly 60,000 people in the USA receive general anesthesia (GA) for surgery alone everyday without anesthesiologists using any direct measure of the brain to confirm unconsciousness.
A study in the Proceedings of the National Academy of Sciences of the United States of America noted that changes in heart rate, blood pressure, and muscle tone represent the only standards by which we measure brain state - along with presumed drug pharmacokinetics, pharmacodynamics, and level of exhaled gas.
By assessing behavioral and electrophysiological changes, researchers were able to gain more direct insight into the mechanism of propofol-induced unconsciousness and establish electroencephalography signatures of the brain state that could be used to monitor the brain activity of patients receiving general anesthesia.
The standard approach to diagnosing gastric cancer (GC) is to conduct an upper digestive endoscopy with biopsy along with a histopathological evaluation of the biopsy material. Not only is this procedure unavailable in the developing world, but also - with regard to the endoscopy - of little clinical value.
Currently, there is a demand for a simpler, non-invasive test to select people who may have a higher risk for GC. To explore this possibility, a study in the British Journal of Cancer studied a nanomaterial-based breath test to identify gastric issues that are due to GC.
The preliminary results of the study show that the simple test is also effective in accurately distinguishing GC from benign stomach disorders.
By Peter Sergo, medwireNews Reporter