Grommets

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Acute non-specific low back pain in primary care

Acute non-specific low back pain, usually a result of muscle strains and ligament sprains from lifting, exercising or moving unexpectedly, is commonly encountered in primary care. At any given time, approximately one in five adults will report low back pain. Although non-specific low back pain is usually self-limiting and improves with time, there is an array of treatment options to facilitate this process and to minimise potential suffering, disability and absenteeism from work. This article will provide a review of such treatment options

Evidence-based treatment of acute otitis externa

Acute otitis externa (AOE), or diffuse inflammation of the external ear canal, causes a range of symptoms, including otalgia, otorrhoea, hearing loss and itching. Despite AOE being common, with a 12-month prevalence of approximately 1%, there is a paucity of evidence-based treatment guidelines. This contributes to a wide variation in its management, especially in general practice. In particular, there appears to be confusion over the roles of topical and oral antibiotics, as well as concerns about ototoxicity and the emergence of microbial resistance potentially caused by topical preparations. This article reviews the current evidence-based treatment of AOE

What is hyoscine N-butylbromide?

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Evidence that changes the way you practice Bipolar Disorder: Mania and depression explained

Bipolar Disorder (BD) is characterised by alternating discrete episodes of depression and mania.1 Rational pharmacotherapy necessitates an appreciation of these different phases and of the possible underlying pathophysiology. A greater understanding of the pathogenesis of BD has boosted awareness of how anti-bipolar drugs work, and vice versa.2 This bidirectional relationship has amplified knowledge in both disciplines

Insomnia disorder: when sleep plays coy, aloof and disdainful

Intermittent or acute insomnia is common and may sometimes require short term treatment with approved hypnotic agents. A diagnosis of insomnia disorder, however, indicates that poor night-time sleep is chronic and is accompanied by significant impairment of daytime functioning. Although insomnia disorder often co exists with psychiatric and medical conditions, it is viewed as an independent entity with potentially serious sequelae, requiring its own treatment, usually in the form of cognitive behavioural therapy (CBT), with or without pharmacotherapy.Keywords: Insomnia, hypnotics, cognitive behavioural therap

Statins: Evidence for effectiveness

Since their introduction in 1987, statins have become the largest-selling prescription drugs worldwide, and have kept both the scientific and lay press captivated. There were reports this year alone that statins may prevent hysterectomies in women with fibroids, are linked to better health outcomes after brain haemorrhage, may protect against the microvascular complications of diabetes, as well as against cerebral reperfusion injuries, may lower the risk of Barrett’s oesophagus, alter the inflammatory response to the common cold, slow the progression of advanced multiple sclerosis, and offer added benefit to men with erectile dysfunction.1 Amid this hype and against a backdrop of more the a billion people potentially taking statins,11 the obvious question is whether or not current evidence on the safety and efficacy of statins still overwhelmingly favours these agents for their licensed indication of lowering cholesterol and preventing cardiovascular disease morbidity and mortality

Cognitive enhancement: a brief overview

Cognitive enhancement involves the non-medical use of illicit and/or prescription drugs, such as agents prescribed for attention deficit/hyperactive disorder (ADHD) and narcolepsy, usually in order to stay awake and to counteract fatigue and loss of concentration, generally in the context of high workload and stress. Growing interest in taking prescription stimulant drugs for non-licensed purposes to improve academic, work and sporting performance has raised medical, ethical and regulatory issues.Keywords: ADHD, attention deficit/hyperactivity disorder, cognitive enhancement, high workload, narcolepsy, stres

Stress-related IBS

The gastrointestinal tract is exquisitely sensitive to different physical and psychological stressors. Irritable bowel syndrome (IBS) may be viewed as a disorder caused by stress-induced dysregulation of the complex interactions along the brain-gut-microbiota axis, which involves the bidirectional, self-perpetuating communication between the central and enteric nervous systems, utilising autonomic, psychoneuroendocrine, pain modulatory and immune signalling pathways. An overzealous stress response may significantly alter not only the sensitivity of the central and enteric nervous systems, but also other potentially important factors such as gut motility, intestinal mucosal permeability and barrier functioning, visceral sensitivity, mucosal blood flow, immune cell reactivity and enteric microbiota composition. Symptoms of these (mal)adaptive changes may include constipation, diarrhoea, bloating and abdominal pain, manifesting clinically as IBS. This article briefly reviews the current postulated stress-models of IBS.Keywords: stress, allostatic load, irritable bowel syndrome, brain–gut–microbiota axi

Switching antidepressants

Switching antidepressants because of lack of efficacy or unacceptable side-effects, while often required in general practice, may result in toxic drug-drug interactions, worsening depression or unpleasant discontinuation reactions. Switching strategies to minimise these risks include immediate switching, cross-tapering or incorporating a washout period. Immediate switching is generally possible when substituting a selective serotonin reuptake inhibitor or a serotonin and noradrenaline reuptake inhibitor for a drug from its own class. Cross-tapering over a period of weeks is preferred when switching between different antidepressant classes or from high-dose antidepressants. Dangerous interactions necessitate the observance of an adequate washout period when switching to and from monoamine oxidase inhibitors.Keywords: switching antidepressants, discontinuation reactions, immediate switching, cross-tapering, washout perio