Sleep Disorders

Antiretroviral Therapy: Darunavir: An Overview of an HIV Protease Inhibitor Developed to Overcome Drug Resistance

abstract: Depression and anxiety are common comorbidities in patients with chronic obstructive pulmonary disease (COPD), and like COPD, they are often underrecognized. Both of these comorbidities can adversely affect the course of COPD. Anxiety, for example, is associated with more severe dyspnea, greater disability, and impaired functional status; it also is a significant predictor of hospitalizations for acute exacerbations of COPD. When evaluating depressive symptoms, it is important to rule out cognitive impairment, particularly in patients with severe COPD and hypoxemia. Treatment options include antidepressants and cognitive behavioral therapy. Participation in a pulmonary rehabilitation program also can help reduce anxiety and depressive symptoms in patients with COPD. (J Respir Dis. 2007;28(3):94-103)

A 43-year-old woman presented withuncontrolled type 2 diabetes mellitus.Her hemoglobin A1c level was 12%,and self-measured glucose levels hadbeen above 400 mg/dL for 3 months.She was taking insulin 70/30,70 units twice daily.

MELBOURNE, Australia -- For children with intermittent asthma, a short course of Singulair (montelukast), a leukotriene antagonist, given at the first sign of an episode may reduce acute care visits, reported Australian investigators.

ATHENS, Greece -- Greek men and women who took a midday nap at least occasionally had a 12% lower risk of coronary mortality, according to a study here, and those who napped for at least three times per week did three times as well.

EVANSTON, Ill. -- Children who get less sleep than recommended are significantly more likely to be overweight or obese than their peers who get the right amount of sleep.

PITTSBURGH -- Common symptoms of depression such as fatigue, sleep disturbances, and anhedonia may trigger initima-media thickness changes associated with subclinical atherosclerosis, researchers here reported.

GLASGOW, Scotland -- About half of patients with newly diagnosed epilepsy will have good control of their seizures with the first medication tried, and a majority of responders will be seizure-free at the lowest dose, reported European investigators.

A 69-year-old man with a history of atrial fibrillation, pulmonary embolism, asthma, and obstructive sleep apnea presented to the emergency department for evaluation of dyspnea and light-headedness. He had been treated for paroxysmal atrial fibrillation over the past 5 years; fairly good control had been achieved with metoprolol and amiodarone. However, over the past several months, he had been experiencing intermittent episodes of atrial fibrillation.

ABSTRACT: Heel pain that occurs with the first several steps in the morning and diminishes as walking continues is the classic symptom of plantar fasciitis. Assessment of risk factors, such as improper footwear, a change in physical activities, and a new running surface, is important. Radiographs are rarely useful. Plantar fasciitis is generally self-limited; symptoms typically take 6 to 18 months to resolve. Conservative measures may include relative rest, stretching, strengthening, shoe modifications, orthoses, night splints, NSAIDs, and ice therapy. A corticosteroid injection may be warranted in resistant cases. If extensive conservative treatment is unsuccessful, referral to an orthopedic surgeon may be indicated.

For several days, the left eye and eyelids of a 60-year-old obese man had been red and irritated. The symptoms were worse in the morning after waking. The patient had recently started wearing a nighttime continuous positive airway pressure mask for obstructive sleep apnea (OSA). He slept exclusively on his left side.

BETHESDA, Md. -- Nearly three million Americans are living after a stroke, reported government researchers. There are more than two million patients with epilepsy, and migraine affects more than 35 million lives.

CHAPEL HILL, N.C. -- Intracranial bleeding in newborns has been found common after a vaginal birth, although the bleeding is limited and apparently has no effect, according to researchers here.

OXFORD, England -- Efforts to quit smoking with Chantix (varenicline), the nicotine-receptor partial agonist, may be more successful than with Zyban (bupropion), according to a Cochrane review.

DETROIT -- Patients with mild symptoms of sleep apnea are less likely to follow treatment plans using a positive airway pressure machine (PAP), found researchers here.

WATERTOWN, Mass. -- Instead of popping pills, men with erectile dysfunction may be able to improve their performance through weight loss and getting in shape.

ROCKVILLE, Md. -- The demand for obesity surgery has swelled by nearly 2,000% from 1998 to 2004, according to the federal Agency for Healthcare Research and Quality.

PITTSBURGH -- Poor sleep is a frequent companion of depression in children, according to researchers here.

A study conducted in France provides further evidence of how allergic rhinitis adversely affects quality of life. Léger and associates found that allergic rhinitis impairs all dimensions of sleep quality.

ABSTRACT: Irritable bowel syndrome (IBS) is characterized by abdominal pain or discomfort, bloating, and constipation or diarrhea; the pain is typically relieved by defecation. The diagnosis is not one of exclusion; it can be made based on the answers to a few key questions and the absence of "alarm" symptoms. Fiber therapy, the elimination of particular foods, and regulation of bowel function can help relieve symptoms. Tegaserod or polyethylene glycol can be used to treat IBS with constipation. Loperamide and alosetron are of benefit in IBS with diarrhea (although the latter carries a small risk of ischemic colitis). Low-dose tricyclic antidepressants may be used to treat the abdominal pain associated with IBS. Probiotic therapy or rifaximin may help reduce bloating. Psychological therapies seem to improve well-being in patients with IBS.

A 5-year-old boy was referredfor evaluation of afemur fracture. A day earlier(while his mother was atwork), the boy had jumpedoff the back of his father’spickup truck, which wasparked in the driveway. Theboy’s older and youngerbrothers were present andreported the incident to thefather. The father found the childsitting on the ground; the child toldhis father that his leg hurt and thathe wanted to go to sleep. Apparently, the father putthe child to bed. The mother reported that on the morningof admission, the child was wearing the sameclothes as when she had left for work the previous day.The child could not walk, although he was able to bearsome weight; his mother brought him to the hospital.There was no other history of acute trauma involvinghis leg.

Q:How can I accurately determine when a patient’s hypertension isresistant to treatment-and what is the best approach to theevaluation?

abstract: The keystone of influenza prevention is still vaccination. The 2 available types of influenza vaccine--the inactivated vaccine, which is administered intramuscularly, and the attenuated vaccine, which is delivered via nasal spray--have efficacy rates of 70% to 80%. Unfortunately, only about 65% of persons who should receive the influenza vaccine are, in fact, vaccinated. The neuraminidase inhibitors oseltamivir and zanamivir are 70% to 90% effective in preventing influenza. These antivirals also are effective in reducing the severity of influenza symptoms and the duration of illness when administered within 48 hours of the onset of clinical disease. Some patients have difficulty in self-administering zanamivir because the inhalation process is fairly complicated. Because of the resistance pattern observed in 2005, amantadine and rimantadine are not currently recommended for prophylaxis or therapy. (J Respir Dis. 2007;28(1):21-29)

A 62-year-old woman was found on thefloor of her bathroom at home with herwheelchair partially on top of her.She was unresponsive except to painfulstimulus.

In his Hypertension Q&A, “When Snoring Has More OminousConsequences Than a Sleepless Spouse” (CONSULTANT,October 2003, page 1410), Dr Donald Vidt suggestsseveral questions that a physician can ask patients to screenfor obstructive sleep apnea (OSA).