Current medical research and opinion
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It is well known that patients suffering from bronchial asthma undergoing surgical procedures requiring general anesthesia (GA) or the administration of water soluble radiographic contrast media (RCM) have an increased risk of potentially severe bronchospasm. Nevertheless, little attention has been devoted to the possible preventive measures to reduce the occurrence of this potentially life-threatening event. It has been shown that the most important risk factor for bronchospasm during GA induction and/or the use of RCM is represented by a high degree of bronchial hyperreactivity with airway instability not adequately controlled by long-term anti-inflammatory treatment. ⋯ The authors suggest a therapeutic approach before surgical procedures requiring GA and/or RCM administration based on the degree of asthma control as assessed by clinical/functional criteria. In this setting, in addition to the necessity of obtaining the best control of airway reactivity, the authors suggest that an optimal control of asthma symptoms in 'real life' conditions might likely constitute a safety issue in asthmatic patients in the case of emergency procedures.
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Multicenter Study
Relative strength of relationships of nasal congestion and ocular symptoms with sleep, mood and productivity.
Nasal congestion associated with allergic rhinitis has been shown to be the most bothersome symptom. Ocular symptoms may be troublesome to patients as well. ⋯ Although nasal congestion is generally more strongly related to the patient-reported outcomes, ocular symptoms have a significant negative effect on patients' lives. Study limitations include: (1) only baseline data were used because of greater severity and variability of symptoms scores; we are unable to establish causal relationships or discuss change, only correlation/covariation; (2) recruitment took place from September through November, thus different patients might have been recruited if sampling took place during the spring; (3) patients were screened for nasal congestion not for ocular symptoms, though there was high co-occurrence of each. These limitations aside, congestion and ocular symptoms are troublesome to patients and typically co-occur. Evaluating and treating these symptoms are key to managing allergic rhinitis and improving patient-reported outcomes.
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To examine the distribution of diabetic medications among adults with type 2 diabetes, and the association between glucose control and treatment approach in the US population. ⋯ Use of multiple oral agents among adults with type 2 diabetes has increased (sulfonylurea and metformin, p = 0.03, triple therapy, p = 0.02). However, nearly half of adults with type 2 diabetes have HbA1c levels above ADA guidelines for control, indicating that available treatments could be used more optimally, and new diabetic agents may be needed.