Heparin-induced thrombocytopenia: how to manage it, how to avoid it

Heparin therapy has two potential adverse effects: bleeding and heparin-induced thrombocytopenia (HIT). There are two types of HIT: type I is more common but less severe; type II occurs less frequently but involves severe thrombocytopenia and a high risk for thrombotic events. Treatment involves discontinuing heparin, allowing the platelet count to return to normal, and treating any thrombosis. Lepirudin (Refludan) is the only agent currently approved for the treatment of HIT-related thrombosis, but other agents may have a role in combination therapy. Prevention includes using low molecular weight heparin instead of unfractionated heparin and limiting unfractionated heparin therapy to less than 5 days.     

Chronic daily headache: how to manage it?

The role of daily analgesic use (also called abuse) in chronic daily headache (CDH) for the maintenance of chronic headache is discussed. The comprehension of the underlying mechanisms of actions is lacking mainly because of the absence of animal models. The abuse should be considered as a compulsive behavior rather than linked to the type of analgesic used and related both to “how” the drug is taken and to “what” drug is used. Moreover, there is no evidence of addictive personality in these patients, and also predictive factors for the long-term outcomes are inconsistent. In the literature specific indications are lacking for the treatment to be performed in these patients. In conclusion, the main problem for these patients is to manage their headaches, and the aim of the therapy should be to enable patients to feel in control of their migraine rather than feel that migraine or analgesic drugs control them. Correspondence to L.A. Pini     

Health and wellbeing part 2: how to manage stress

The first article in this two-part series discussed research on health and wellbeing in healthcare and signposted resources on coping strategies to prevent stress. This second article discusses strategies to help health professionals look after themselves by being aware of their personality. It also aims to encourage them to look at what they can influence and control so they can be more proactive and effective.     

Allergic disease: how to recognize and manage three common types

Allergic disease usually appears in childhood and can continue throughout life, varying in manifestations and severity with age. The diagnostic and therapeutic pearls included here are presented to aid in clinician in coping with this changeability.     

Shedding: how to manage a common cause of hair loss

Although telogen effluvium, or shedding-the most common type of diffuse hair loss in both women and men-is usually self-limiting, the condition may become chronic if the trigger is not identified and corrected. The authors discuss the physiologic and emotional triggers, clinical presentation, diagnosis, and management strategies, including the importance of patient education and reassurance.     

The "chronic" ear: how to manage mild to severe otitis

Otitis media initially involves only the mucosa, but if unchecked, may eventually spread to bone, causing bony erosion and severe osteitis that can have life-threatening CNS complications. Placement of a PE tube generally is all that is necessary to eliminate middle ear fluid and restore normal hearing in serous otitis media and adhesive otitis media. Mastoidectomy is required in more advanced chronic ear disease; if disease is not too extensive, hearing may be restored by tympanoplasty.     

Glucocorticoid-induced diabetes and adrenal suppression: how to detect and manage them

Glucocorticoids, commonly used to treat multiple inflammatory processes, can cause hyperglycemia, Cushing syndrome, adrenal suppression, and, when they are discontinued, adrenal insufficiency. Physicians must be aware of these adverse effects and be equipped to manage them.