BMJ comes out with review article on Febrile seizures

This clinical review summarises how to recognise a febrile seizure and rule out other underlying causes. How to manage febrile seizures and how to deal with common questions posed by parents in this situation.

Comparative effectiveness and tolerance of treatments for H pylori

This network meta-analysis compares different eradication treatments forHelicobacter pylori.This showed that concomitant treatments, 10 or 14 days of probiotic supplemented triple treatment, levofloxacin based triple treatment, hybrid treatment and sequential treatment might be most effective for eradicating H pylori.

Nagging people is a futile exercise

  

Columnist Margaret McCartney argues that nagging people about the need to do exercise to achieve health won’t work. Exercise should be for the people, by the people, she says.

Longer Work Hours Tied To Increased Risk For Stroke

The Los Angeles Times (8/20, Kaplan) reports in “Science Now” that people “who put in long hours at the office were 33% more likely to suffer a stroke than their colleagues who clocked out earlier,” according to study findings published online yesterday in The Lancet. The study also found that even people “who worked just over 40 hours per week saw a significant increase in stroke risk.”

        The New York Times (8/20, Saint Louis) “Well” blog points out that the “new analysis includes data on more than 600,000 individuals in Europe, the United States and Australia, and is the largest study thus far of the relationship between working hours and cardiovascular health.” Included in the analysis were 17 “studies of stroke” that “included 528,908 men and women who were tracked on average 7.2 years,” as well as 25 studies of “coronary heart disease among workers” that involved some “603,838 people.”

        TIME (8/20, Basu) reports that the study authors are not sure why longer work hours appear to be linked to an increased risk for stroke, but posited that “working long hours tends to be correlated with risky health behaviors, like drinking more alcohol or sitting for hours at a time.” Such behaviors, in combination “with the stress associated with working overtime, could be a perfect recipe for a stroke or cardiovascular strain.” The Telegraph (UK) (8/20, Knapton) also covers the study.

CPAP Alternatives For Traveling With Obstructive Sleep Apnea

By Dr Deepu

The Sleep Review (8/20, Wolski) reports on “easy to use, effective, and unobtrusive” alternatives to CPAP for patients with OSA while traveling. Dr. Glenn Adams, medical director and sleep medicine specialist at Sarasota Memorial Health Care System, said one of the most effective options is “Provent, which goes over the nose and creates back pressure to treat OSA,” but is not covered by insurance. The piece also discusses the option of oral appliances.

FDA grants “fast track” designation to pneumonia drug

By Dr Deepu

FDA grants “fast track” designation to pneumonia drug

The Triangle (NC) Business Journal (8/19, deBruyn, Subscription Publication) reports that Chapel Hill-based drug developer Cempra Inc. received “Fast Track” designation from the FDA to expedite the review process for “Cempra’s experimental drug solithromycin, a treatment for community acquired bacterial pneumonia (CABP).” The drug is “currently in Phase 3 development for the treatment of CABP and Cempra plans a New Drug Application submission in 2016.”

Combined use of antidepressants and painkillers linked to bleeding risk

Extra vigilance needed when using both types of drugs together

Taking a combination of antidepressants and common painkillers is associated with an increased risk of bleeding soon after starting treatment, finds a study published in The BMJ this week.

The researchers say their results may have been affected by other unmeasured or unknown factors and should be interpreted with caution. However, they suggest special attention is needed when patients use both these classes of drugs together.

Depression produces the greatest decrement in health of all common chronic conditions and depression in older people is an important public health problem.

But concern exists that antidepressants may interact with common painkillers called non-steroidal anti-inflammatory drugs (NSAIDs) to increase the risk of bleeding inside the skull (intracranial haemorrhage).

So a team of researchers based in Korea compared the risk of bleeding among patients treated with antidepressants with and without NSAIDs.

Using the Korean nationwide health insurance database, their study involved over four million people who were prescribed antidepressants for the first time between 2009 and 2013.

NSAID prescriptions were obtained and hospital records were used to identify time to first admission with intracranial haemorrhage within 30 days of a new prescription. Factors that could affect the results, such as age, sex, and use of other medications, were taken into account.

Compared with use of antidepressants alone, the team found that combined use of antidepressants and NSAIDs was associated with a substantially increased bleeding risk.

They found no statistically meaningful differences in risk of bleeding between different types of antidepressant drugs, or with age. Being male was the most common factor for a higher risk of bleeding with combined use of antidepressants and NSAIDs.

"The addition of NSAIDs to antidepressant treatment increased the risk of intracranial haemorrhage within 30 days of the combination starting, especially in men," conclude the authors. "This result adds to evidence confirming the increase of risk with combination use of antidepressants and NSAIDs."

In an accompanying editorial, Dr Stewart Mercer at the University of Glasgow and colleagues at the University of Cambridge, say the results give some cause for concern.

They point out that both types of drug are widely used, and that co-morbidity of the conditions for which these drugs are used is very high - 65% of those with major depression also have chronic pain.

They urge family doctors to be extra vigilant in terms of prescribing behaviour and discussing the risks with patients, especially in deprived areas where "the combination of mental and physical problems (including chronic pain) is very common." And they say further research is required to extend the findings over longer time periods and in differing populations.

Link to full