Natural therapy: Physicians

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Thursday, July 11, 2013

Primary Care Physicians Unable to Form Early Diagnosis of Cervical Spondylotic Myelopathy

This is an important finding, because previous studies have shown that early diagnosis and treatment of CSM lead to better outcomes. The majority of patients initially sought a diagnosis for their symptoms from family physicians, who arrived at a correct diagnosis in only 4.8% of cases and never at the first clinic visit. Many other patients initially consulted community-based orthopedic surgeons, only one of whom suspected CSM at the first visit. Detailed findings of this study are reported and discussed in the article "Delayed diagnosis of cervical spondylotic myelopathy by primary care physicians," by Eyal Behrbalk, M.D., Khalil Salame, M.D., Gilad J. Regev, M.D., Ory Keynan, M.D., Bronek Boszczyk, Dr. Med., and Zvi Lidar, M.D., published today, in the July 2013 issue of Neurosurgical Focus.

Cervical spondylotic myelopathy (CSM) has been called the most common form of spinal cord dysfunction in older adults, although it can occur in younger people due to injury. As we age, vertebral joints in our necks begin to show wear (cervical spondylosis) and cervical spine ligaments thicken. These changes cause the spinal canal to narrow, which can lead to compression of the spinal cord. As spinal cord compression increases, nerve cells die, resulting in symptoms of cervical myelopathy that range from mild neck pain to motor weakness, sensory loss, impaired walking, and, in cases of advanced disease, loss of bladder and bowel control. CSM is a progressive disease. Surgery is indicated when there is neurological impairment. Studies have shown that outcomes of surgery are best when the operation is performed during the early stages of the disease, when neurological impairment is minimal.

Between January 2009 and December 2010, 146 patients underwent surgery for CSM at The Spine Unit of Tel-Aviv Medical Center, a tertiary care center. All cases of degenerative pathological conditions of the cervical spine were included. Complete medical records (from both the Center and community-based physicians' offices) were available for 42 patients, and these patients comprised the study population. The researchers collected data from the time the first signs or symptoms of CSM were documented until the date of surgery. The diagnosis of CSM was based on the following: 1) symptoms consistent with CSM; 2) neurological findings suggestive of myelopathy; and 3) MRIs showing compression of the cervical spinal cord. In addition to the review of medical records, phone interviews with patients were conducted to obtain any missing clinical data.

Behrbalk and colleagues found that 69% of patients initially sought a diagnosis for their symptoms from family physicians and 21.4% from community-based orthopedic surgeons. The remaining patients consulted other physicians, none of whom was a neurologist or neurosurgeon, the most likely to recognize the disease. The researchers state that this follows the normal pattern of physician visits in Israel, where patients can directly schedule appointments with family physicians and orthopedic surgeons but require referrals to see neurologists or neurosurgeons. During the first physician visit, only one doctor?an orthopedic surgeon?suspected that CSM could be the underlying cause of the patient's symptoms.

At the second physician visits, most patients went to orthopedic surgeons (48.8%) and family physicians (26.8%); far fewer saw neurologists (9.8%) or neurosurgeons (2.4%). At the third physician visit, patients continued to consult orthopedic surgeons most frequently (38.5%), but more patients sought out neurologists (25.6%) and neurosurgeons (18%) than before; 12.8% of patients returned to family physicians.

In this study, Behrbalk and colleagues found that it took a mean of 5.2 ? 3.6 physician visits to obtain the correct diagnosis of CSM. In the end, the diagnosis was made most often by neurosurgeons (38.1%) and neurologists (28.6%), and less frequently by orthopedic surgeons (19%), family physicians (4.8%), and a variety of other specialists (9.5%). The delays in diagnosis in this study, according to the researchers, rest primarily on a lack of awareness of CSM on the part of family practitioners and community-based orthopedic surgeons, who did not conduct full neurological examinations that could indicate myelopathy.

Given that CSM is a progressive disease, the researchers point out that delays in diagnosis can mean that "patients are referred to surgery at an advanced stage of the disease, at which point they are suffering from severe, often irreversible neurological damage."

Behrbalk and colleagues call for continued education of family practitioners and community-based orthopedic surgeons to make them more aware of CSM and promote early referrals for surgery when patients present with CSM symptoms.

Source-Eurekalert

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Monday, June 24, 2013

Physicians Say Soaring temperatures can affect quality of pills

by Sheela Philomena on May 25, 2013 at 13:12 new drugs extreme heat may affect drugs, say researchers. Doctors Say Soaring Temperatures can Affect Quality of Pills
"Quality of medicines may deteriorate during the summers due to high temperatures. Since most of the drugs are designed to be stored at normal room temperature, no drug should be exposed to temperatures over 86 (30 degrees Celsius),"medical Delhi (DMA) Association, in a press release here.

According to doctors, chemists and pharmaceutical manufacturers must store the products out there at an ambient temperature of 68 degrees fahrenheit (22 degrees Celsius) to 77 degrees fahrenheit (25 degrees Celsius).

"In fact, 68-77 degrees fahrenheit is the interval in which manufacturers guarantee the integrity of the product. Anywhere from 58 (14.5 degrees Celsius) to 86 (30 degrees Celsius) is still very well, "said K.K. Kohli, Secretary of State of the DMA.

He warned that some drugs, including nitroglycerin (used to treat heart ailments) and insulin (used for diabetes), are particularly sensitive to heat.

"Both insulin and nitroglycerin are usually transported by patients, who need to take them when they suffer from pain in the chest or high blood sugar. Thus, a dose damaged these essential medication can be fatal. Some antibiotics break and may damage stomach or kidneys, "the DMA statement added.

Kohli said that due to high temperatures even common drugs can break down and have potentially harmful effects.

"Drugs such as aspirin which is exposed to changes in temperature and can cause more than the usual stomach upset. Hydrocortisone cream can separate and become useless in the heat. Thyroid, birth control and other drugs that contain hormones are particularly sensitive to changes in temperature, and when the fact of protein it hot changes properties, "said Kohli.

Giving advice on how to protect away medicines from changes in temperature, doctors advise to keep medicines in a place fresh and dry as a corridor, bedroom closet linen closet or even a kitchen cabinet, away from the stove. Unopened insulin bottles can be stored in the refrigerator.

"Never take any medication that has changed color or consistency, regardless of the expiration date." Also check an unusual smell. "Throw pills that stick, are chipped or are harder or softer than normal, added the declaration of DMA.

Source-IANS

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