spring 2009

P E R S P E C T I V E S
Sinus infections, new dementia tool, Type 1 diabetes


Don Lane Photo

 

Dr. Susan King

It’s safe to say that although we are into spring, the respiratory tract viruses are certainly not yet ready for a vacation.

By Dr. Susan King

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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Nexus is published quarterly for Newfoundland and Labrador's physicians. It is a forum for the exchange of views, ideas and information for members.