Sleep Disorders

GENEVA, Switzerland -- No individual chronic disease - not angina, not arthritis, not asthma, not diabetes -- is more disabling than depression, according to a World Health Organization study.

MONTREAL -- Vivid dreams of babies in peril are common to pregnant women and newly delivered mothers, often inspiring wakefulness and a postpartum need to check on the infant.

TOKYO -- Second-hand cigarette smoke can exacerbate the sleep disturbances of pregnant women, investigators here found in two surveys of nearly 36,000 women.

LEUVEN, Belgium -- Just because adolescents go to bed, that doesn't mean they stop calling and texting their friends, and that may leave them bleary-eyed in the morning, researchers here reported.

abstract: While the risk factors for aspiration pneumonia are similar to those for aspiration pneumonitis, the 2 syndromes have different presentations. Aspiration pneumonia tends to occur in older patients or in those with neurological diseases, and the aspiration is not usually witnessed. Aspiration pneumonitis is more likely to occur in patients undergoing anesthesia or in those with acute drug and alcohol overdoses, and the aspiration is often witnessed. The workup may include bedside assessment of the cough and gag reflexes, chest radiography, videofluoroscopic imaging, or fiberoptic endoscopy. Empiric antibiotic therapy should be avoided in most patients with pneumonitis; however, antibiotics may be indicated for those at high risk for bacterial colonization of oropharyngeal and gastric contents who have fever, increasing sputum production, or new infiltrates or for those who fail to improve within 48 hours. (J Respir Dis. 2007;28(9):370-385)

Current evidence suggests that out-of-office blood pressure measurements and 24-hour ambulatory blood pressure monitoring are better predictors of cardiovascular risk than routine office measurements. Is it time to make greater use of automated devices in my practice?

BETHESDA, Md. -- Emphasizing that asthma affects different patients in different ways, the National Asthma Education and Prevention Program has issued new evidence-based guidelines on the disease.

PROVIDENCE, R.I. -- Depression and living in a dank, moldy home are linked, but a lack of control and mold-related health problems also play a role, researchers said.

LEXINGTON, Ky. -- Intensive behavioral therapy helped severely obese patients lose at least 100 pounds in 44 weeks and maintain 60% of the loss at five years, researcher here reported.

URBANA, Ill. -- About 2% of children and adolescents in the U.S. and United Kingdom have restless legs syndrome, estimated an international team on the basis of a large survey.

PARIS -- Anesthetic infusion directly into the wound after colorectal cancer surgery may improve pain control and speed recovery, researchers found.

ROCKVILLE, Md. -- Nursing mothers with a genetic predisposition for rapidly metabolizing codeine in pain medication can seriously overdose their babies with morphine, the FDA warned today.

ROCHESTER, Minn. -- Obesity is more than twice as likely to be treated seriously if physicians jot the formal diagnosis down in medical records -- a relatively uncommon act by clinicians here.

WINSTON-SALEM, N.C. -- One-time percutaneous radiofrequency ablation proved completely successful in eradicating small renal cell carcinomas, found researchers here.

MONTREAL -- For children with attention-deficit hyperactivity disorder who sleep poorly, methylphenidate (Ritalin) helps make them alert when they are awake.

ABSTRACT: Antidepressants and psychotherapy are effective treatments for major depression. In selecting an antidepressant, consider any previous response or family history of a response to a medication as well as anticipated side effects. Advise patients that antidepressants take at least 4 to 6 weeks to have a full therapeutic effect and that only about half of patients respond to the first drug prescribed. If the patient fails to respond or experiences intolerable side effects, it is usually advisable to substitute an antidepressant with a different mechanism of action. A combined approach using medication and psychotherapy often produces optimal results.

ABSTRACT: Angiotensin-converting enzyme inhibitors and ß-blockers are the cornerstone of heart failure medical therapy; unless contraindicated, start these agents as soon as possible after volume status has been optimized. Aldosterone receptor antagonists, angiotensin-receptor blockers, and a fixed-dose combination of hydralazine and isosorbide dinitrate (the last recommended especially for African Americans) can be used as add-on therapy. Prophylactic implantable cardioverter defibrillators reduce long-term mortality in symptomatic patients with a left ventricular ejection fraction (LVEF) of 35% or less. Cardiac resynchronization therapy improves symptoms and ventricular remodeling in some patients; indications include wide (more than 20 milliseconds) QRS complex on ECG, impaired LVEF (35% or less), and advanced heart failure symptoms (NYHA classes III and IV) despite optimal drug therapy. Measurement of natriuretic peptides and impedance cardiography both show promise for monitoring patients with heart failure and for guiding therapy, but definitive data to justify their routine use are still lacking.

TORONTO -- Donepezil (Aricept) helped stave off fading cognition in patients with severe Alzheimer's but failed to otherwise stem the advance of the disease, researchers found.

MONTREAL -- Newborns placed in a sitting position-in car seats, baby carriers, or infant seats, for example-may have an increased risk of sudden infant death, researchers reported here.

REYKJAVIK, Iceland -- A major symptom of restless legs syndrome has been associated with a genetic variation on chromosome six, two research groups reported.

SAN FRANCISCO -- Poor-quality sleep and cognitive decline appear to go hand-in-hand among older women, but it's unclear which leads to the other, investigators here suggested.

SAN ANTONIO -- High-dose therapy with the selective serotonin reuptake inhibitor (SSRI) sertraline resulted in statistically and clinically significant improvement in isolated impaired executive function in older patients.

SEATTLE -- Commercial airline passengers flying long distances at typical cabin pressures may have discomfort that falls just short of mountain sickness, researchers reported.

A 53-year-old woman presented to the emergency department complaining of substernal chest pain that awoke her from sleep. The chest pain was associated with left shoulder numbness, radiating to her back, and was partially alleviated with sublingual nitroglycerin. During this episode, the patient had a cough productive of yellow phlegm and one instance of cough productive of 1 tbs of bright red blood.

Heart failure is prevalent in both primary care and cardiology practices. It develops in about 1 in 5 persons during their lifetime and in about 1 in 8 of those who have not sustained a myocardial infarction (MI). Heart failure is also the leading cause of hospitalization in the elderly.