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spring 2009 |
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P
E R S P E C T I V E S
Sinus
infections, new dementia tool, Type 1 diabetes
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Don Lane Photo |
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Dr. Susan King |
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It’s safe to say that
although we are into spring, the respiratory tract viruses are certainly
not yet ready for a vacation.
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By Dr. Susan King |
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It’s safe to say that although we are
into spring, the respiratory tract viruses are certainly not yet
ready for a vacation.
I recently attended a session on treatment
of sinus infections, given by Dr Boyd Lee, ENT specialist. We all see
patients who have interpreted the symptoms of sinus inflammation from a
viral upper respiratory tract infection as those of a bacterial sinus
infection, with the expectation of antibiotic treatment. Dr Lee reminded
us that a bacterial sinus infection comes as a complication of a URTI
and as such is not likely to be present until the URTI has been present
for seven to10 days and has its own set of diagnostic criteria. We are
aware that Nasonex is indicated for adjunctive treatment of bacterial
sinus infections; a three-week treatment is recommended.
There have been recent studies showing
that Nasonex alone, i.e. without an antibiotic, has been shown to
effectively treat a properly clinically diagnosed mild to moderate
bacterial maxillary sinus infection. Results were as good as, or better
than, antibiotic treatment. He points out, however, that frontal sinus
infections, although less common, are more serious and are best treated
with antibiotics.
Speaking of sinuses, there has been a lot
of publicity regarding sinus rinses, which have been shown to help
symptoms. The devise used is reusable; the solution is pricey. Dr Lee
provided us with a recipe: 1 liter of boiled (5 minutes) cooled water, 1
tsp salt, 1 tsp baking soda, 1 tsp sugar. This is cheap, balanced and
effective.
New tool for assessing dementia
The other session I was able to attend was
on dementia, presented by a neurologist with a special interest in
behavior. He spoke of a new clinical tool, developed in Canada, the
Montreal Cognitive Assessment, known as MoCA. It incorporates sequential
trail completion and the old familiar clock drawing. A score of < 26 has
good sensitivity and specificity for dementia. It is available as a
free download.
Type 1 diabetes
Finally, I attended a session on diabetes.
One thing I was reminded of was the occurrence of Type 1 diabetes in
adults, even obese patients. There needs to be an increased suspicion of
this in lean patients and in those with weight loss at diagnosis. If
there is suspicion, a c-peptide level can be ordered. This measures
natural secreting insulin and if low is indicative of Type 1 diabetes.
The key issue is that a sulfonylurea or insulin might be considered
earlier in these patients.
So much to learn, so little opportunity;
thought I’d pass these little tidbits on, in case they haven’t made it
your way yet! Happy spring.
Dr. Susan King is a family physician at
the Newfoundland Drive Medical Clinic in St. John’s. Tips and hints may
be emailed to nexus@nlma.nl.ca or faxed to (709) 726-7525.
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