Macter's Clinical Excellence & Leadership Program (CELP)
Focused on oophthalmology and ENT
in the Seventh session of CELP's National CME Series 2008
KARACHI: The 7th session of the National CME series for family physicians under Macter and Clinical excellence & Leadership Programme was held recently at LNH , Karachi. The programme was largely attended by General Practitioners from across Karachi and Sindh.
More than 600 doctors have so far registered themselves in this ongoing event.
The seventh session was focused on oophthalmology and ENT and was addressed by Dr Saeed Akhtar consultant ENT surgeon, Dr Zia Rizvi consultant ENT specialist and Dr Sadaf Zia, Dr Imaran Ghayur consultant ophthalmologist LNH, Dr Abdul Hameed and Dr Ataur Rehman
Dr Saeed Akhtar apprised the participants about Rhinusinusitis (RSS), a very common condition seen by the GPs in their daily practice. Dr Saeed informed the participants that the commonly used term sinusitis has now been replaced by Rhinusinusitis because sinusitis is preceded by rhinitis and rarely occur alone.
He said that the condition is diagnosed largely on the presenting symptoms, a diagnostic criteria was set in 1997 for RSS , the disease is classified into acute, subacute, recurrent acute and chronic according to the duration of symptoms.the distinction between the viral or bacterial RSS is not so marked, he added.
Dr Seed stressed family physicians upon the need of examination which requires a good light and well illuminaterd room and the basic instruments and you can visualize any gross pathology if present.
Talking about the investigations he told that the sinus X rays are rarely helpful in the diagnosis. CT scan is considered to be the gold standard if the diagnosis of RSS is in question.
About the management of RSS Dr Saeed that the general goals are control infection
diminish tissue edema & reverse sinus ostial obstruction so mucopus can drain
In order to best prevent or slow the development of antibiotic-resistant bacteria - avoid prescribing antibiotics for trivial indications.In general – symptomatic treatment & reassurance for mild symptoms.more severe symptoms or acutely ill - use the narrowest spectrum antibiotic possible, he further added.
Cigarette smoke, gastroesophageal reflux, injudicious use of decongestants are the predisposing factors for the development of chronic RSS informed Dr Saeed and stressed on not using the topical decongestants for longer periods
Dr Zia Rizvi in his presenetation discussed in detail the incisdence, prevalence, risk factors and management of oral cancer.
Dr Zia reveals the fact that in the geographical zone Pakistan was having the high risk for head and neck cancer , he stressed upon the need of early diagnosing the disease as this was the only way which can made things better. Dr Zia was with the opinion that the family physicians must carefully examine the patients , take a good history , look if there is any risk factors present and should have a diagnostic workup as these are thetools which help in early diagnosis of the disease. He heavily urged upon the need of educating people and highlighted the role of family physicians in this respect, he told the audience that use of GUTKA alone contribute to this fatal disease and measures to be taken at the government level to prohibit the sale this filthy thing and people should be educated at every lavel to curb the use of gutka.
Regarding the diagnosis dr Zia informed that biopsy was the only modality that can distinguish between a benign and malignanat lesion.
Taking biopsy of growth result in the spread of cancer and pinbless mass in the neck is harmless, these are the two myths which are prevalent in our society and anf family physicians can play an important role in educating and and convincing the patients that this was not true.
“little extra time, relevant history and a good clinical examination can make a difference between life and death” was the take home message by Dr Zia Rizvi.
Speaking about the Pediatric deafness problems Dr Sadaf Zia said most of the time these cases are gone unnoticed by the GPs. She highlighted the fact that bottle feeding snd mothers who smoke were predisposing factors for the development of acute otitis media in children of less than 5 yrs of age, acute otitis media if overlooked can lead to deafness
She informed that a referral should be made to the ENT specialist when any child who is not developing speech by 1-2 years of age ,having persistent Secretory Otitia Media (SOM) or Recurrent Secretory Otitia Media,Ch.Otitis media and Choleatetoma
Dr AbdulHameed in his predentsstion discussed commonly occurring eye diseasesfor which patients come to see the GP.
Dr Hameed’ s presentation was very informative and contained visuals of slmost all the common eye diseases which really helped the audience in understanding the lecture in a better way.
Dr Hameed urged the doctors for immediate referral to an ophthalmologist whenever a patient comes with a comp;lain of decreasing vision, sudden painful loss of vision or with corneal ulcers or abscesses as this can lead to permanent loss of visionnif not treated adequately. Contact lens us ewas a common cause of corneal ulcers he added
Dr ataur rehman in his presentation addressdthe screening procedures of diabetic nephropathy and when to mad erefereral to the ophthalmologist. He informed the audience that during the past decade Diabetes has emerged as one of the major health problems in Pakistan & is one of the most common causes of blindness.
A diabetic is 10-20 times more likely to become blind than a non diabetic & indeed diabetes is the most common cause of blindness in the 40-60 year age group, he further added. Dr Ata elaborated the role of family physicians in detail and said that the role physician of a physician is evry important , the doctor can help in preventing diabetic blindness by Good metabolic control, which delays onset of DR & slows its progression. Decreases the incidence of macular oedema & therefore less need for LP. He listed the risk factors for the development of diabetic retinopathy DR rarely develops within 5 yrs of onset of DM.,Risk of DR is 50% if the duration of DM is 10yrs or more.Risk of DR is 90% if the duration of DM is 30 yrs or more.poor metabolic control, poorly controlled hypertension and severe renal disease. Obesity, Smoking & Hyperlipedemia were also associated with progression of DR, Dr Ata added
Dr Imran Ghayur the senior consultant opthamolgist of the LNH in his presentation discussed the technical advances in ophthalmology. He informed the doctors that the new treatment modalities are safe, effective , shortens hospital stay as most of these procedures are carried out in aday care setting.
Dr Ghayur with the help of real time videos of different operative procedures performed in ophthalmology try to make the audience to understand in a more better way this was of great interest for the audience and they highly appreciated it.
