Category Archives: Neurology

A bacterial cause accounts for 2%-10% of acute rhinosinusitis cases.

Nose and nasal cavities. Image source: Wikipedia, public domain.

Recommendations for Management of Acute Bacterial Sinusitis by the Infectious Diseases Society of America (IDSA):

Bacterial rather than viral rhinosinusitis should be diagnosed when any of the following occurs:

- persistent symptoms lasting at least 10 days, without improvement
- symptoms or high fever and purulent nasal discharge or facial pain for 3–4 days at illness onset
- worsening symptoms after an initial respiratory infection, lasting 5–6 days, has started to improve.

Empirical therapy should be started as soon as acute bacterial rhinosinusitis is diagnosed clinically.

Amoxicillin-clavulanate, instead of amoxicillin alone, is recommended for both children and adults.

Macrolides and trimethoprim-sulfamethoxazole are not recommended as empirical therapy, because of high rates of antimicrobial resistance.

References:

Algorithm for the management of acute bacterial rhinosinusitis (figure)
Guideline Issued for Managing Acute Bacterial Rhinosinusitis - Physician's First Watch http://bit.ly/TGn6aM
IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults http://bit.ly/TGnaHB

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People who meet the 7 healthy goals recommended by the American Heart Association are less likely to die of cardiovascular causes.

Here there are:

- not smoking
- moderate exercise at least 5 times a week
- untreated blood pressure under 120/80
- HbA1c under 5.7%
- total cholesterol under 200 mg/dL
- BMI less than 25
- a diet high in produce, fish, and whole grains, and low in sodium and sugary beverages

Less than 2% of people reached all 7 ideals.

Those who met 6-7 goals had reduced risks for all-cause mortality (hazard ratio, 0.49), compared with participants meeting zero or one goal.

References:

Healthy Habits Associated with Reduced Mortality Risk - Physician's First Watch http://bit.ly/N9x8ha
Trends in Cardiovascular Health Metrics and Associations With All-Cause and CVD Mortality Among US Adults - JAMA http://bit.ly/N9xzYO
Image source: OpenClipart.org, public domain.

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Public release date: 15-Aug-2012 [ | E-mail | Share ]

Contact: Rachel Seroka rseroka@aan.com 612-807-6968 American Academy of Neurology

MINNEAPOLIS People who are free of dementia and have high levels of a protein that indicates the presence of inflammation have relatives who are more likely to avoid the disease as well, according to a new study published in the August 15, 2012, online issue of Neurology, the medical journal of the American Academy of Neurology.

"In very elderly people with good cognition, higher levels of C-reactive protein, which is related to inflammation, are associated with better memory," said study author Jeremy M. Silverman, PhD, with Mount Sinai School of Medicine in New York. "Our results found that the higher the level of this protein in the study participant, the lower the risk for dementia in their parents and siblings."

For the study, researchers identified 277 male veterans age 75 and older and free of dementia symptoms. They were given a test that measured levels of the protein. Next, the group was interviewed about 1,329 parents and siblings and whether they had dementia. A total of 40 relatives from 37 families had dementia. A secondary, independent group of 51 men age 85 and older with no dementia symptoms were given an interview about 202 relatives for dementia. Nine of the relatives had dementia.

Study investigators found that participants who had higher amounts of the protein were more than 30 percent less likely to have relatives with dementia. Similar results were found in the secondary group. Since the protein levels were not associated with years of education, marital status, occupation and physical activity, these factors could not account for the lower risks seen.

"This protein is related to worse cognition in younger elderly people. Thus, for very old people who remain cognitively healthy, those with a high protein level may be more resistant to dementia," said Silverman. "Our study shows that this protection may be passed on to immediate relatives."

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The study was supported by the National Institute on Aging, United States Department of Veterans Affairs, the Berkman Charitable Trust and the Alzheimer's Association.

To learn more about dementia, visit http://www.aan.com/patients.

Go here to see the original:
Resistance to dementia may run in the family

Methodist Sugar Land Neurology Associates is proud to welcome Larry Tran, M.D., to their practice.

We are very delighted to have Dr. Tran join our group, said Eddie Patton Jr., M.D., with Methodist Sugar Land Neurology Associates. He shares the values-based, personal approach to quality patient care that makes Methodist unique and this relationship such a great fit. Our patients will benefit from his personal nature and passion for neurology.

Its an honor to join the outstanding staff at Methodist Sugar Land Neurology Associates, said Dr. Tran, a board certified neurologist with fellowship training in neurophysiology from University of Texas Health Science Center at San Antonio. My mission is to deliver quality care in a patient oriented environment. I also strive to achieve open communication with my patients in an effort to work as a team to develop treatment plans, all the while keeping them updated on the latest advances in treatment and care.

Methodist Sugar Land Neurology Associates offer diagnosis and treatment of the most common and most complex neurological disorders. From sleep apnea, migraines, epilepsy and dementia, to complex spine, peripheral neurological disorders and neuromuscular disorders, the physicians at Methodist Sugar Land Neurology Associates can provide answers and options using the latest technology and therapeutic techniques, backed by the resources and staff of Methodist Sugar Land Hospital.

Methodist Sugar Land Neurology Associates is located at 16659 Southwest Freeway, Suite 131 in Medical Office Building II. To schedule an appointment, please call 281-494-6387.

See more here:
Methodist Sugar Land Neurology Associates welcomes Dr. Larry Tran

PHILADELPHIA - The Philadelphia Eagles today announced they will be collaborating with the Child Neurology Foundation (CNF) to sponsor a program for first and second-year students from the six regional medical schools in the Delaware Valley. The programpromotes the neurological specialty, which cares for the one-in-four children who face problems that affect the developing nervous system. Students will have the opportunity to hear directly from child neurologists as well as families who can describe their personal experiences. This marks the third time that the Eagles and CNF have partnered together.

The students will visit Eagles training camp on Sunday, August 12thand will have an opportunity to meet Eagles players, including Mike Patterson, following afternoon practice. "This is an exciting way to expose students to a rewarding field that they might not have otherwise considered," remarked CNF president Dr. Lawrence Brown. "Though our doctors are heroes, it still helps to have the drawing power of the Eagles to fill our VIP tent."

The Child Neurology Foundation supports research and provides information, education, and advocacy for child neurologists, other medical professionals, patients, parents, and member-groups that deal with an array of neurologic conditions, towards the treatment and care of the 18 Million Children (one in four) throughout North America who experience neurologic disorders, including autism; cerebral palsy; epilepsy; migraine; ADHD; and hundreds of other disorders affecting the developing nervous system.

More here:
Eagles Host Child Neurology Foundation at Training Camp

Only 61% of the eligible population in the USA gets screened for this common cancer, according to The Lancet.

Here are some excerpts from the new guidance for colorectal cancer screening by the American College of Physicians (ACP):

- colorectal cancer screening should start at the age of 50 years for people at average risk, and at 40 years (or 10 years before the age of the youngest case of colorectal cancer in a family) for people at high risk

- stool-based tests, flexible sigmoidoscopy, and optical colonoscopy are all acceptable screening options for people at average risk

- the gold standard—optical colonoscopy—is recommended for people at high risk

- screening should be stopped for adults aged over 75 years or who have a life expectancy of less than 10 years

Colorectal cancer screening can lead to harmful outcomes such as perforation, bleeding, and false-negative results.

10 Questions You Need to Ask About Colonoscopy

From The NYTimes:

1. Why is effective bowel preparation important?
2. How can I maximize my chance of an effective bowel preparation?
3. Are there certain medications I should stop taking before colonoscopy?
4. Are all colonoscopists equally effective at finding polyps and cancers during colonoscopy?
5. How can I be sure that my colonoscopist will do a careful examination?
6. How can I reduce the risk of a complication during colonoscopy?
7. Should I try colonoscopy without sedation?
8. If I undergo sedation, should it be given by an anesthesiologist?
9. Do all colonoscopists follow the same rules to determine when my colonoscopy should be repeated?
10. Why aren’t the problems with the delivery of colonoscopy already solved?

Questions # 1, 2, 3, 6, 7 are very important, question # 10 probably not so much.

17% of U.S. hospitals now provide virtual colonoscopy

Medicare does not currently reimburse routine screening with virtual colonoscopy, but it does cover evaluations with "regular" colonoscopy.

References:

New guidance for colorectal cancer screening. The Lancet, Volume 379, Issue 9820, Page 978, 17 March 2012.
Virtual Colonoscopy Gains in Popularity. Is It Right for You? TIME.
Colonoscopy Developer Dies at 94 - NYTimes http://goo.gl/iBnOp - Dr. Wolff was unconventional and surely made headlines in his day.
When President Obama underwent his first-ever colon cancer screening last year, he chose virtual colonoscopy. USA Today.
Cleveland Clinic Colorectal Cancer Risk Assessment Tool. Get your score in 2 minutes (free).
Image source: Colon (anatomy), Wikipedia, public domain.

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