Macter's Clinical Excellence & Leadership Program (CELP)
Issues and updates on General Surgery discussed in the Sixth session of CELP's National CME Series 2008
KARACHI: The sixth
session of the National CME Series (Jan-Dec 2008) for
family physicians under Macter's Clinical Excellence & Leadership Program (CELP) was held at Liaquat National Hospital, Karachi on 26 June 2008 and was attended by around 300 family physicians from across Karachi and parts of Sindh.
The sixth CME session was devoted to general surgical problems encountered by family physicians in their practices. The format of the 6th session was different from the preceding sessions as the topics were covered in an interactive panel discussion instead of the traditional presentations.
The panel consisted of Dr. Salman Faridi consultant surgeon LNH, Dr Rufina Soomro consultant surgeon LNH, Dr Turab Pishori and Dr Nadeem Khurshaidi
This one-year certificate CME series—comprising 12 monthly sessions covering 16 key specialties in 33 lecture units—will offer latest updates on diagnosis and treatment of some of the most important medicine and allied topics and diseases seen by family physicians on daily basis. Each CME session is held on the last Thursday of every month at LNH’s main auditorium.
The panelists started the discussion with thyroid diseases. To a question regarding the use of L - thyroxine in pregnant patient Dr. Turab replied that such cases should be referred to endocrinologists as every thyroid case is not subjected to surgery, he added.
Dr. Khurshaidi informed the participants that TSH was the diagnostic marker of the disease and the ultrasound scan and FNAC plays a decisive role in reaching the decision whether to operate on it or not.
Dr. Faridi told the participants that the true isolated nodule is not as common as it was thought clinically. FNA could not distinguish between benign and malignant follicular lesion and cytology is the test to make the diagnosis he added. Dr. Faridi stressed on the need of thoroughly examining the swelling before diagnosing it as thyroid related lump.
Dr. Rufina explained to the participants that pregnancy related endocrine changes make things complicated and the sensitivity and specificity of FNAC depends upon the expertise of the pathologist she added.
Responding to a question Dr. Khurshaidi said that FNAC is now the established modality for differentiating thyroid nodule into benign or neoplastic. He further informed the participants that today the surgery in benign cases is purely performed due to cosmetic reasons. With the advent of new treatment modalities the role of surgery has some what declined.
Dr. Turab advised that, help should be sought from the endocrinologist, surgeons and radiologist.
To a question regarding abdominal pain and abdominal tuberculosis Dr. Rufina replied that the empirical therapy should be started and the patient must be followed closely. Dr. Khurshaidi pointed out that in women with abdominal pain, suspected abdominal mass & a raised CA 125 — is not always an ovarian tumor, as CA 125 could also be elevated in abdominal tuberculosis.
Responding to a question about the anti tuberculous therapy in a patient with axillary lympadenopathy showing caseous necrosis, Dr. Faridi said the therapy could be initiated but it was better to first have a smear of caseous material.
Talking about the rectal bleeding and perianal problems Dr. Rufina informed the participants that people in our region are unaware of the perianal problems other than hemorrhoids (piles) and consider themselves as having piles regardless of the cause of rectal bleeding. Telling about the anal related problems even to the doctor was a stigma and was a barrier in medical and surgical referral. In our society, the family physicians should sense the responsibility of educating the patients so that, they do not shy away in revealing their problems.
Dr. Turab informed the participants that, the patients with anal fissure, abscess, fistula and rectal cancer — present with similar signs and symptoms, he stressed upon the importance of diagnosing rectal cancer as this may be masked by other commonly occurring rectal conditions and could go undetected. Dr. Rufina stressed that the general physicians should differentiate rectal bleeding and acute anal conditions and all one need is a good clinical examination. She further told that a very few patients require surgery for hemorrhoids as there were other effective modalities like sclerotherapy and rubber band ligation were available. “Do not label bleeding patients with piles until proven” added Dr. Khurshaidi. Replying to a query Dr. Turab mentioned the importance of high fiber diet in relieving constipation.
Dr. Rufina elaborated the importance of screening in breast disease and informed the participants that the screening should be started at the age of 35 yrs and at the age of 30 yrs in those cases where there is a positive family history of breast cancer & other risk factors present. Addressing to the female general practitioners Dr. Rufina said that by keeping in view our social and religious norms and the reluctance of the female patients it was their duty to teach female patients the procedure of self breast examination as this can help in early detection of this grave disease and would also help preventing the advancement of the disease to a late stage even the trained midwives can play a significant role in this regard she added.
This CME program is organized by Macter International as a part of its CELP activity.
The next CME session will be held on July 31, 2008 InshaAllah and will cover issues in ENT, Ophthalmology and Psychiatry related to the practice of family physicians. The speakers and panelists of the forthcoming CME session include Dr. Saeed Akhtar, Dr. Shakeel Aqil, Dr. Moin Ahmed Ansari, Dr. Abdul Hameed, Dr. Hanif Chatni and Dr. Imran Ghayoor.
