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Sunday, 9 December 2012

L'Amour, carotid and stroke

As cinema, Michael Haneke's l'Amour is a human drama about the effect of illness on family (partner and next generation), the reality of managing a progressively failing spouse at home, challenges of involving carers, perspectives of young protégé, of emergency services, of remote relatives ...
A subtext is personalising the question:why stroke(s) in this slim elderly woman, the mystery of the transient cerebral ischaemic attack - micro-emboli? transient local clot on a narrow artery? ...
And the human impact of the dilemma:what to do about severe carotid disease and minimising risk of surgery?

See recent blog on predicting and suppressing cerebral micro-emboli in patients with carotid disease.

Saturday, 8 December 2012

Sleeping pills and risk of pneumonia

Research published in the journal Thorax has suggested that commonly prescribed sleeping tablets - benzodiazepines - are linked to increased risk of pneumonia, and to risk of 30 day and longer term mortality in patients diagnosed as having had community acquired pneumonia.  Reasons are unclear however these medicines may both impair immune responses and reduce the depth of breathing, thus making it more difficult for microbes to be cleared from the lungs. Reported risk of pneumonia was more evident with longer term use of sleeping tablets. 
Of note, this was a case control  study and thus at much greater risk of inadvertent bias as a reason for the findings than more reliable double blind, randomised controlled trials. It would be expected that patients with greater overall disease burden would be at higher risk of pneumonia if the relationship with treatment were due to 'cause and effect'. However the reverse was reported by the study authors. 
This work suggests the need for further studies to explore these potential risks in more detail. 
Meantime, there are risks to stopping these medicines suddenly. Patients with concerns should contact their medical advisor or pharmacist for advice.